Improving access to care for survivors of gender-based violence through task sharing with non-physician providers in Ethiopia: experience from a pilot project

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Tufa, Adisu Gebre-michael, Metti Midekssa, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6748476/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 Background Gender-based violence (GBV) is a pervasive public health and human rights issue in Ethiopia, characterized by high prevalence and limited access to care. Systemic barriers, including stigma, a shortage of trained providers, and the centralization of services in hospitals located in major cities, significantly hinder timely support for survivors. Care is typically delivered by a small number of gynecologists and obstetricians, further constraining access. This pilot project aimed to evaluate the effectiveness of task sharing, delegating GBV care to trained non-physician providers, in addressing these gaps at two health centers in Ethiopia. Methods This pilot project employed an implementation research approach to evaluate the operational and technical feasibility and effectiveness of task sharing in GBV care at two health centers in Ethiopia. Fourteen mid-level providers (health officers, midwives, and nurses) received comprehensive training in medical evaluation, psychosocial support, and legal referrals. The project included baseline facility assessments, structured training, ongoing mentorship, and community engagement. Data were collected through service records, client satisfaction interviews, and stakeholder consultations. Results Over one year, 45 survivors of GBV received comprehensive care, with 66.7% presenting within 72 hours of the incident. Sexual violence was the most frequently reported form, accounting for 66.7% of cases. Trained providers delivered key services, including HIV testing (95.6%), emergency contraception and post-exposure prophylaxis for HIV (46.7%), sexually transmitted infection prophylaxis (44.4%), and psychosocial support (93.3%). Legal service linkages were established for 84.4% of survivors, and only three cases (6.7%) required referral to higher-level facilities. Client satisfaction was high, with over 90% of respondents reporting positive care experiences. Stakeholders expressed strong support for scaling up the intervention. These findings underscore the effectiveness of the task-sharing approach in expanding access to essential, survivor-centered GBV care. Conclusion and lessons learned Task sharing proved feasible and effective in decentralizing GBV care, improving accessibility, and reducing referral burdens. Key lessons include the importance of structured training, continuous mentorship, and multi-sectoral collaboration. This model offers a scalable solution to enhance GBV care in low-resource settings. Sexual & Reproductive Medicine Gender based violence task-sharing non-physician providers Ethiopia Figures Figure 1 Introduction Gender-based violence (GBV) is a critical public health and human rights issue in Ethiopia, deeply entrenched in societal norms and unequal power dynamics between women and men. The consequences of GBV extend far beyond immediate physical harm, significantly impacting survivors' mental health, economic stability, and overall well-being ( 1 ). A meta-analysis of studies on violence against women in Ethiopia revealed a staggering lifetime prevalence of sexual violence at 39%, with higher risks among women with lower education levels, rural residence, and limited income ( 2 ). The 2016 Ethiopia Demographic and Health Survey (EDHS) further highlighted the widespread nature of GBV, reporting that 23% of women aged 15–49 had experienced physical violence, while 10% had endured sexual violence ( 3 ). Disturbingly, regional disparities exist, with physical violence ranging from 6% in the Somali region to 28% in Oromia. GBV is also linked to severe mental health outcomes, including depression, anxiety, and substance abuse, as evidenced by studies on marginalized groups such as housemaids and participants in intervention programs ( 4 , 5 ). Despite the high prevalence of GBV, access to care remains alarmingly low. Only 23% of survivors seek assistance, a figure that underscores systemic barriers such as the lack of dedicated GBV clinics, societal stigma, and the normalization of violence ( 3 , 6 – 8 ). Services are largely hospital-based and delivered by a relatively small number of gynecologists and obstetricians, creating barriers for timely and comprehensive support. The shortage of such trained healthcare professionals exacerbates the problem, leaving many survivors without critical medical, psychological, or legal support ( 9 ). Cultural factors, including the perception of GBV as a private matter and fear of retaliation, further discourage reporting ( 7 ). Legal frameworks, while progressive on paper, are poorly enforced, with significant gaps in addressing intimate partner violence and rape ( 10 ). These challenges are compounded by weak judicial and police systems, which often fail to hold perpetrators accountable ( 1 , 10 ). Task sharing, a strategy that delegates clinical and support responsibilities from gynecologists and obstetricians to trained non-physician providers, has emerged as a promising solution to address healthcare gaps in resource-limited settings. This model has been successfully implemented in other areas, such as mental health and maternal care, and is increasingly recognized for its potential to expand GBV services ( 9 , 11 ). By equipping mid-level providers (e.g., nurses, midwives, and health officers) with specialized training, task sharing can decentralize care, reduce wait times, and improve accessibility for survivors, particularly in underserved regions ( 11 ). Studies have shown that non-physician providers can deliver high-quality, trauma-informed care with adequate training, mentorship, and resources ( 9 ). The pilot project aimed to evaluate the feasibility, acceptability, and effectiveness of task sharing in GBV care at two health centers in Ethiopia. By demonstrating the potential of task sharing to bridge the GBV care gap, this project offers a scalable model for improving survivor outcomes in Ethiopia and similar low-resource settings. Methods and Materials Study design This pilot project employed an implementation research approach, combining elements of operations research to evaluate the feasibility, acceptability, and early outcomes of a task-sharing model for gender-based violence (GBV) care in primary health care settings. The project aimed to integrate GBV services into routine health care by empowering mid-level, non-physician providers to deliver first-line medical and psychosocial care and facilitate legal support. Setting and baseline assessment The baseline assessment was carried out by St. Paul Institute for Reproductive Health and Rights (SPIRHR), the project owner, across six health centers under the Addis Ababa City Administration and Oromia Regional State during June 2022. The facilities included Afincho Ber, Kotebe, and Saris in Addis Ababa, as well as Alemgena, Sebeta, and Burayu in Oromia. The primary objective was to evaluate the existing service landscape and identify suitable sites for pilot implementation. A structured checklist was used to assess each facility’s readiness to provide GBV services, covering four key domains: background information, physical infrastructure, human resources, and service delivery components. Interviews were conducted with facility heads to gauge management commitment and perspectives on decentralizing GBV care. Self-reported information was verified through direct observations by the project coordinator. Findings revealed that while all centers expressed readiness and had taken initial steps, such as allocating rooms and initiating staff training, critical gaps remained. Most centers lacked dedicated spaces for psychosocial care, social workers, or waiting areas. Although all had examination rooms and toilets, only a few had spaces for investigations. Human resource capacity varied, with staff ranging from 4 to 30 per facility. Only three of the six centers had staff with prior GBV training (nine individuals in total). Documentation of GBV cases was inconsistent. Overall, while there was the commitment to provide GBV services, readiness was limited by insufficient infrastructure, inconsistent service documentation, and a lack of trained personnel. A project launching workshop was held with the participation of key stakeholders, including representatives from the Oromia Regional Health Bureau, Addis Ababa City Administration Health Bureau, Federal Ministry of Health, Ministry of Justice, the heads of the two participating health centers, and representatives from both the Oromia and Addis Ababa Police Commissions. During the workshop, inputs were gathered to inform the implementation of the project. The representative from the Ministry of Justice presented on the current status of one-stop center establishment and the Ministry’s role in supporting GBV response. Additionally, officials from the two regional health bureaus shared updates on the existing GBV care services and reaffirmed their commitment to supporting the project. Project implementation Based on the baseline findings, two model sites were selected for the pilot: Afincho Ber Health Center (Addis Ababa) and Burayu Health Center (Oromia). Selection was based on caseload volume, available infrastructure, and leadership commitment. The health center management teams identified and assigned mid-level, non-physician providers to participate in the project. Fourteen healthcare providers (3 males, 11 females), including Health Officers ( 4 ), Midwives ( 6 ), and Nurses ( 4 ), were trained in comprehensive GBV management with practical attachment in two one-stop centers in Addis Ababa (Tirunesh Bejing and Ghandi Memorial Hospitals). The initial training lasted two weeks and covered: Survivor-centered care and psychosocial first aid; GBV-related history taking and physical examination; Clinical management, including emergency contraception, PEP, and STI prophylaxis; Medico-legal documentation and preparation of medical certificates for legal use. A five-day refresher training was conducted midway through the implementation period to reinforce key skills and address practical challenges identified during service delivery. In addition, three mid-level providers with prior experience in GBV care were newly engaged from Burayu Health Center to strengthen the team. Pre and post-training assessments were conducted to evaluate participants’ knowledge and core competencies in GBV care. The average post-test score was 92%, with individual scores ranging from 85–95%, indicating strong comprehension and skill acquisition following the training. The selected health centers were equipped with essential medical supplies and equipment needed to provide GBV care. Ongoing clinical mentorship was provided by senior gynecologists and obstetricians from St. Paul’s Hospital Millennium Medical College (SPHMMC), supported by a WhatsApp group for real-time case discussions. Referral linkages were established with SPHMMC’s Departments of Obstetrics & Gynecology and Forensic Medicine for cases requiring advanced clinical or forensic care. To enhance legal system integration, a one-day sensitization and training session was conducted for four police officers and three public prosecutors, led by an experienced legal expert specializing in GBV cases. Community awareness was also prioritized. Through collaboration with existing urban and rural health extension programs, the project conducted advocacy sessions to inform community leaders and residents about the availability of GBV services at the pilot sites. A total of 65 community members participated in a dedicated one-day advocacy event. The project was effectively implemented over a one-year period between June 2022 and July 2023, although the total duration of the pilot extended slightly beyond one year. Two no-cost extension periods were granted due to unforeseen challenges beyond SPIRHR’s control. Data sources Multiple data sources were used to inform the evaluation of the pilot. These included: Routine service delivery data and patient registers are maintained at the health centers; Structured facility assessment checklists; Qualitative feedback collected through interviews with health center managers and community stakeholders; Endline client phone satisfaction interviews and a stakeholder consultation workshop Key indicators and outcome measures Key process and outcome indicators included: Perceived readiness and capacity of health facilities; Number and profile of GBV survivors receiving care; Types of GBV encountered and timeliness of presentation; Services provided (laboratory tests, emergency contraception, PEP, injury care, referrals, and legal linkages); Proportion of survivors receiving comprehensive GBV care; User satisfaction was assessed using a 19-item Likert-scale questionnaire, in which service users rated each item on a five-point scale: “strongly disagree”, “disagree”, “uncertain”, “agree”, and “strongly agree”. Stakeholder perceptions on scalability and sustainability Ethical considerations The project protocol was reviewed and approved by the Civil Society Coordination team of the Partnership and Cooperation Directorate at the Federal Ministry of Health, Ethiopia. Ethical clearance was granted following a thorough review and incorporation of comments from the Ministry. All participant feedback and data collection activities respected principles of confidentiality, voluntary participation, and informed consent. Results GBV case load and survivor profiles Over the one-year pilot implementation period, a total of 45 survivors of gender-based violence (GBV) received care at the two pilot health centers: 16 (35.6%, n = 16/45) at Afincho Ber (Addis Ababa City Administration) and 29 (64.4%, n = 29/45) at Burayu Health Center (Oromia Regional State). Nearly half of the survivors, 22 (48.9%, n = 22/45), were under the age of 18. The vast majority were female (97.8%, n = 44/45), with only one male survivor (2.2%, n = 1/45). Regarding educational status, 23 (51.1%, n = 23/45) had completed elementary education, while 8 (17.8%, n = 8/45) were unable to read and write. Most survivors were single (82.2%, n = 37/45), and 26 (57.8%, n = 26/45) were students (Table 1 ). Nature and pattern of violence The majority of GBV cases involved sexual violence (66.7%, n = 30/45), followed by physical violence (17.8%, n = 8/45), and mixed forms (15.6%, n = 7/45). The most commonly reported perpetrators were intimate partners (44.4%, n = 20/45), followed by family members (22.2%, n = 10/45) and strangers (22.2%, n = 10/45). Attempted rape was reported by 11 survivors (24.4%, n = 11/45), while 25 (55.6%, n = 25/45) experienced forced rape. Ten (22.2%, n = 10/45) of the survivors reported a history of rape by the same perpetrator. Fresh physical injuries such as tears and bruises were observed in 17 survivors (37.8%, n = 17/45). Timeliness of care-seeking was generally favorable in which 66.7% (n = 30/45) of survivors arrived within three days of the incident, which is considered the optimal window for forensic evidence collection and for initiating emergency clinical interventions such as post-exposure prophylaxis (PEP) and emergency contraception (Table 2 ). Service utilization and clinical management Upon presentation at the health centers, survivors received a range of laboratory investigations. HIV testing was conducted for 43 (95.6%, n = 43/45), pregnancy tests for 34 (75.6%, n = 34/45), HBsAg testing for 32 (71.1%, n = 32/45), and VDRL testing for 31 (68.9%, n = 31/45). Emergency contraception and PEP for HIV were each provided to 21 (46.7%, n = 21/45) of the eligible survivors, while STI prophylaxis was given to 20 (44.4%, n = 20/45). Psychosocial first-line support was provided to 42 (93.3%, n = 42/45), and standard treatment for injuries was administered to 40 (88.9%, n = 40/45). Legal service linkage was established for 38 survivors (84.4%, n = 38/45). While health centers previously referred all GBV cases to hospitals for further care, during the pilot period, only 3 (6.7%, n = 3/45) cases were referred: 2 from Afincho Ber and 1 from Burayu (Table 3 ). Client satisfaction and perceived quality of care To assess client satisfaction and perception of service quality 73.3% (n = 33/45) of survivors (12 from Afincho Ber and 21 from Burayu) participated in a telephone interview conducted by trained healthcare providers not directly involved in their care. The majority of respondents either “agreed” or “strongly agreed” to all positive statements related to service accessibility, quality, provider communication, respect, and affordability. For example, 100% of survivors from Afincho Ber and 90.5% from Burayu indicated they were satisfied with the GBV care received. Survivors also reported high levels of trust in health providers and perceived the care environment as respectful and supportive (Table 4 ). Stakeholder perspectives A stakeholder consultation workshop was conducted involving 16 participants, including healthcare providers, representatives from the Ministry of Justice and Addis Ababa Police, and health bureau officials from both regions. The consultation revealed a broad consensus on the importance and feasibility of decentralized GBV care delivery. Seventy-five percent of participants recommended scaling up the task-sharing model to other parts of the country, particularly underserved areas, as a sustainable strategy for improving GBV care access and responsiveness (data not shown). Table 1 General socio-demographic characteristics of the GBV survivors managed at the two health centers General characteristics No. % Number per facility Afincho Ber HC 16 35.6 Burayu HC 29 64.4 Age of the beneficiaries =18 years 23 51.1 Gender Male 1 2.2 Female 44 97.8 Educational status of the beneficiaries Unable to read and write 8 17.8 Elementary school 23 51.1 Junior secondary/Secondary 10 22.2 College/University education 4 8.9 Current marital status Single 37 82.2 Married 8 17.8 Occupation Student 26 57.8 Housewife 4 8.9 Daily laborer 7 15.6 Government Employee 2 4.4 Private Employee 1 2.2 Commercial sex worker 4 8.9 Child 1 2.2 Table 2 Type of perpetrators and pattern of gender-based violence experienced by the survivors Pattern of GBV No. Percent Perpetrator Family member 10 22.2 Intimate partner 20 44.4 Stranger 10 22.2 Customer 3 6.7 Neighbor 1 2.2 Co-worker 1 2.2 Type violence Sexual Violence 30 66.7 Physical Violence 8 17.8 Mixed 7 15.6 Number of days after the incident Timely arrival 30 66.7 Late arrival 15 33.3 History of rape By the same person 10 22.2 No past history 35 77.8 Type of rape Attempted rape 11 24.4 Acquaintance rape 1 2.2 Forced rape 25 55.6 other 8 17.8 Presence of fresh tear, bruise Yes 17 37.8 No 28 62.2 Table 3 Care provided by the non-physician care providers after the GBV survivors presented to the health centers Action taken at the health center* No. % Lab tests done Pregnancy test 34 75.6 VDRL 31 68.9 HBsAg 32 71.1 HIV 43 95.6 Prevention of STI and pregnancy Emergency contraception 21 46.7 PEP for HIV 21 46.7 STI prophylaxis 20 44.4 Treatment provided First-line support given 42 93.3 Standard treatment of injury 40 88.9 Legal service linkage 38 84.4 Referral to the hospital for additional care 3 6.7 * The percentages do not add up to 100% Table 4 Perception of the GBV services users about the GBV care provided at Afinicho Ber and Burayu Health Ceners on a Liker Scale Item (n = 33) *Afinicho Ber Health Centre (n = 12) *Burayu Health Centre (n = 21) Agree (%) Strongly Agree (%) Uncertain (%) Agree (%) Strongly Agree (%) Health professionals explain medical tests 0 100 0 42.9 57.1 The GBV unit has essential care resources 8.3 91.7 28.6 19 52.4 The GBV care received is just about perfect 41.7 58.3 0 52.4 47.6 Providers offer psychosocial support 0 100 0 66.7 33.3 Can get GBV care without financial setback 8.3 91.7 0 57.1 42.9 Providers ensure thorough treatment 25 75 0 47.6 52.4 GBV care is affordable 16.7 83.3 0 57.1 42.9 Access to medical specialists when needed 16.7 83.3 47.6 33.3 19 Wait time for GBV care is reasonable 16.7 83.3 14.3 57.1 28.6 Treated with dignity and respect 0 100 0 52.4 47.6 Service is friendly and courteous 0 100 0 57.1 42.9 Providers address concerns adequately 0 100 0 52.4 47.6 Providers listen to patients concerns 0 100 0 47.6 52.4 Trust in healthcare professionals 8.3 91.7 0 42.9 57.1 The center provides all GBV services 33.3 66.7 0 66.7 33.3 Easy to get a GBV appointment 0 100 0 61.9 38.1 Satisfied with the GBV care received 16.7 83.3 0 61.9 38.1 Able to get medical care when needed 0 100 0 71.4 28.6 Can access legal services when needed 0 100 0 66.7 33.3 *NB: The questionnaire was administered by interviewers, and service users did not respond with “Disagree” or “Strongly disagree” to any items at Afincho Ber HC, nor with “Uncertain,” “Disagree,” or “Strongly disagree” at Burayu HC. Hence, these response categories are intentionally omitted from the table for clarity. Discussion This project demonstrated that task sharing in the provision of gender-based violence (GBV) care at the primary health care level is feasible, acceptable, and effective in improving access to essential services. By training and equipping mid-level non-physician providers, the two model health centers successfully managed a good number of cases over one year, with the majority of survivors receiving comprehensive clinical and psychosocial care, as well as legal service linkage without a need to referral to a higher facility. Most survivors presented within the optimal timeframe for medical and forensic intervention, and over 90% reported high satisfaction with the care received. Importantly, less than 10% of cases required referral to higher-level hospitals, demonstrating the capacity of trained mid-level non-physician providers to manage GBV cases locally and reduce the burden on tertiary facilities. These findings of this project align with growing evidence supporting task sharing as a strategy to expand access to essential health services in low-resource settings ( 12 – 14 ). A study that explores the status, successes, challenges, and impacts of the implementation of task sharing for family planning in five sub-Saharan African countries, including Ethiopia, reported increased contraceptive uptake through task sharing to midwives and community health workers, with family planning users rising substantially ( 15 ). Similarly, the study on tubal ligation service delivery in Ethiopia found that health officers trained in the procedure maintained high protocol adherence (96.9%) and achieved high client satisfaction (98.2%), mirroring the strong quality of care and acceptability observed in our GBV pilot ( 16 ). In mental health, the task-shared care for people with severe mental disorders (TaSCS) trial in Ethiopia demonstrated that task-shared care delivered by non-specialists was not inferior to specialist-led care and was cost-effective, an important consideration for scaling GBV services sustainably ( 17 ). The emphasis on comprehensive training and mentorship in our pilot project addresses concerns raised by other task-sharing models regarding variability in non-specialist training and safety ( 12 , 18 ). In our context, a structured two-week training, followed by refresher sessions and ongoing specialist mentorship, helped ensure quality and built provider confidence. The high satisfaction levels reported by GBV survivors in our study further underscore the importance of well-designed training and support systems for successful task-sharing initiatives. One of the key strengths of this pilot project was its successful demonstration of the feasibility and acceptability of task-sharing for GBV care within the primary health care system. By equipping and mentoring mid-level, non-physician providers, the project enabled the delivery of integrated clinical, psychosocial, and legal services at the community level. The fact that two-thirds of survivors presented within 72 hours, the critical window for effective medical and forensic intervention, reflects improved access and responsiveness of the decentralized model. Importantly, the vast majority of cases were managed entirely at the health center level, with only minimal referrals to higher-level hospitals, illustrating the capacity of trained providers to handle GBV cases effectively within primary care settings when supported with the appropriate resources and supervision ( 12 , 19 ). The structured, hands-on training, complemented by continuous mentorship from specialists at SPHMMC, proved essential in enhancing provider confidence and clinical decision-making. A dedicated communication platform allowed for timely consultation, contributing to the quality and consistency of care. Client feedback further validated the success of the model, with over 90% of survivors reporting satisfaction with the care received, particularly in terms of provider communication, respect, privacy, and accessibility. The integration of legal services into the care pathway and the engagement of local law enforcement and prosecutors underscored the value of multi-sectoral collaboration in delivering a coordinated GBV response. The endorsement of the model by the majority of stakeholders, who recommended its expansion to additional sites, indicates strong support for the broader institutionalization of this approach within the health system. While the pilot was implemented in only two health centers and involved a relatively modest number of survivors, the insights gained are nonetheless valuable for informing the scale-up of similar initiatives. Some challenges related to physical infrastructure and structured follow-up of provider performance were noted; however, these are common to many implementation efforts in low-resource settings and can be addressed through ongoing system strengthening. Lastly, client follow-up was conducted via phone interviews, which may have introduced response bias, especially considering the sensitive nature of GBV experiences. Despite these considerations, the pilot offers compelling evidence for the viability of task-sharing in expanding access to high-quality GBV care in primary health care settings. Conclusion and lessons learned This pilot project demonstrated that comprehensive, survivor-centered GBV care can be effectively delivered at the primary health care level through task sharing. By equipping and mentoring mid-level, non-physician providers, health centers were able to offer timely and integrated medical, psychosocial, and legal services to GBV survivors, services that are traditionally limited to higher-level facilities. The successful implementation at Afincho Ber and Burayu health centers provides promising evidence that decentralizing GBV care is not only feasible but also acceptable to both providers and survivors. Key lessons emerged from the one-year proof-of-concept implementation: Task sharing in GBV care is feasible and effective when non-physician providers are adequately trained, supported through continuous mentorship, and provided with the necessary infrastructure and supplies. This approach can significantly reduce the burden on hospital-based services while maintaining the quality of care. Decentralized care at health centers brought services closer to survivors, enabling more timely medical evaluation, emergency interventions (such as PEP and emergency contraception), and linkages to legal support. Coordinated legal support at the health center level facilitated timely documentation of injuries and issuance of medico-legal certificates, strengthening survivors’ access to justice while reducing the logistical and financial burden of seeking care across multiple institutions is achievable. Survivors consistently reported positive experiences related to the quality of care, provider communication, privacy, and trust, highlighting the importance of respectful, accessible, and integrated services at the community level. Abbreviations GBV Gender-based violence EDHS Ethiopia Demographic and Health Survey PEP Post-exposure prophylaxis STI Sexually transmitted infection HIV Human Immunodeficiency Virus HBsAg Hepatitis B surface antigen VDRL Venereal Disease Research Laboratory NPP Non-physician providers SPHMMC St. Paul’s Hospital Millennium Medical College HC Health center MOH Ministry of Health PHC Primary health care TaSCS Task-Shared Care for Severe Mental Disorders SPIRHR St. Paul Institute for Reproductive Health and Rights SSA Sub-Saharan Africa Declarations Acknowledgement St. Paul Institute for Reproductive Health and Rights gratefully acknowledge the healthcare providers and CEOs at Afincho Ber and Burayu Health Centers for their facilitation and dedicated care of GBV survivors. We thank Gynecologists, Obstetricians and Forensic specialist at St. Paul's Hospital Millennium Medical College for their clinical mentorship and training of providers. We appreciate the Federal Ministry of Health, Oromia Regional Health Bureau, and Addis Ababa City Administration Health Bureau for their policy support, and facilitation of project activities, and the Ministry of Justice and Addis Ababa, and Oromia Police Commissions for their collaboration in strengthening legal linkages for survivors. Community leaders and health extension workers were instrumental in awareness efforts. Most importantly, we thank the survivors who shared their experiences, motivating our work to expand survivor-centered care. Conflict of interest The authors have no conflict of interest Source funding This project was made possible through the generous support of Grand Challenges Canada [Grant #: ST-POC-2205-52311]. The views expressed in this manuscript are those of the authors and do not necessarily reflect the official position of the supporting institutions. References Kedir A, Admasachew L (2010) Violence against women in Ethiopia. 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Lancet Psychiatry 9:59–71 Ashengo T, Skeels A, Hurwitz EJH, Thuo E, Sanghvi H (2017) Bridging the human resource gap in surgical and anesthesia care in low-resource countries: a review of the task sharing literature. Hum Resour Health 15:77 Sidat MM (2016) Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems? Comment on Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians. Int J Health Policy Manag Iran 5:725–727 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6748476","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":461832208,"identity":"4e3763d5-1f78-418c-a41e-86383949ba4f","order_by":0,"name":"Mekitie Wondafrash","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-8320-6244","institution":"St. Paul Institute for Reproductive Health and Rights","correspondingAuthor":true,"prefix":"","firstName":"Mekitie","middleName":"","lastName":"Wondafrash","suffix":""},{"id":461832209,"identity":"88eb44bd-a3fc-43b5-ab8b-00b419af4aa9","order_by":1,"name":"Tesfaye H. Tufa","email":"","orcid":"https://orcid.org/0000-0002-8623-9113","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tesfaye","middleName":"H.","lastName":"Tufa","suffix":""},{"id":461832210,"identity":"bcadd7ad-ff82-42e1-9fb5-5e705ea214d8","order_by":2,"name":"Adisu Gebre-michael","email":"","orcid":"","institution":"St. Paul Institute for Reproductive Health and Rights","correspondingAuthor":false,"prefix":"","firstName":"Adisu","middleName":"","lastName":"Gebre-michael","suffix":""},{"id":461832211,"identity":"a0074f29-94fb-4340-9007-ffe50337aab9","order_by":3,"name":"Metti Midekssa","email":"","orcid":"","institution":"St. Paul Institute for Reproductive Health and Rights","correspondingAuthor":false,"prefix":"","firstName":"Metti","middleName":"","lastName":"Midekssa","suffix":""},{"id":461832213,"identity":"f2cd5faa-291c-4a7b-96a3-80b8084bdc21","order_by":4,"name":"Abel Teshome","email":"","orcid":"https://orcid.org/0000-0001-8638-5789","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Abel","middleName":"","lastName":"Teshome","suffix":""},{"id":461832212,"identity":"280820cf-6760-4bf6-b314-8b66f925d3e4","order_by":5,"name":"Wondimu Gudu","email":"","orcid":"https://orcid.org/0000-0003-3850-6712","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wondimu","middleName":"","lastName":"Gudu","suffix":""},{"id":461832214,"identity":"908c452f-9753-4cd6-a7e5-4764284a9f5e","order_by":6,"name":"Lemi Belay Tolu","email":"","orcid":"https://orcid.org/0000-0001-6703-828X","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Lemi","middleName":"Belay","lastName":"Tolu","suffix":""},{"id":461832215,"identity":"f1216640-0869-4f76-8977-1ab34d1095ff","order_by":7,"name":"Delayehu Bekele","email":"","orcid":"https://orcid.org/0000-0002-9243-2622","institution":"St. Paul's Hospital Millennium Medical College, , St. Paul Institute for Reproductive Health and Rights","correspondingAuthor":false,"prefix":"","firstName":"Delayehu","middleName":"","lastName":"Bekele","suffix":""}],"badges":[],"createdAt":"2025-05-26 08:10:00","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6748476/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6748476/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83609562,"identity":"05b7418a-1625-43fc-93cd-5f9e6f4d1f49","added_by":"auto","created_at":"2025-05-29 11:54:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90273,"visible":true,"origin":"","legend":"\u003cp\u003eThe project logic model illustrating the relationship between pilot project resources, components of an intervention and its expected results or outcomes\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6748476/v1/2bb061527b4e5e63677f0b0d.png"},{"id":83609910,"identity":"2d79530a-5e28-45c9-ab82-0f58c13e9498","added_by":"auto","created_at":"2025-05-29 12:02:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1187638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6748476/v1/7bba9312-a781-422c-95cc-455c731d52d5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImproving access to care for survivors of gender-based violence through task sharing with non-physician providers in Ethiopia: experience from a pilot project\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGender-based violence (GBV) is a critical public health and human rights issue in Ethiopia, deeply entrenched in societal norms and unequal power dynamics between women and men. The consequences of GBV extend far beyond immediate physical harm, significantly impacting survivors' mental health, economic stability, and overall well-being (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A meta-analysis of studies on violence against women in Ethiopia revealed a staggering lifetime prevalence of sexual violence at 39%, with higher risks among women with lower education levels, rural residence, and limited income (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The 2016 Ethiopia Demographic and Health Survey (EDHS) further highlighted the widespread nature of GBV, reporting that 23% of women aged 15\u0026ndash;49 had experienced physical violence, while 10% had endured sexual violence (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Disturbingly, regional disparities exist, with physical violence ranging from 6% in the Somali region to 28% in Oromia. GBV is also linked to severe mental health outcomes, including depression, anxiety, and substance abuse, as evidenced by studies on marginalized groups such as housemaids and participants in intervention programs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the high prevalence of GBV, access to care remains alarmingly low. Only 23% of survivors seek assistance, a figure that underscores systemic barriers such as the lack of dedicated GBV clinics, societal stigma, and the normalization of violence (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Services are largely hospital-based and delivered by a relatively small number of gynecologists and obstetricians, creating barriers for timely and comprehensive support. The shortage of such trained healthcare professionals exacerbates the problem, leaving many survivors without critical medical, psychological, or legal support (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Cultural factors, including the perception of GBV as a private matter and fear of retaliation, further discourage reporting (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Legal frameworks, while progressive on paper, are poorly enforced, with significant gaps in addressing intimate partner violence and rape (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These challenges are compounded by weak judicial and police systems, which often fail to hold perpetrators accountable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTask sharing, a strategy that delegates clinical and support responsibilities from gynecologists and obstetricians to trained non-physician providers, has emerged as a promising solution to address healthcare gaps in resource-limited settings. This model has been successfully implemented in other areas, such as mental health and maternal care, and is increasingly recognized for its potential to expand GBV services (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). By equipping mid-level providers (e.g., nurses, midwives, and health officers) with specialized training, task sharing can decentralize care, reduce wait times, and improve accessibility for survivors, particularly in underserved regions (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Studies have shown that non-physician providers can deliver high-quality, trauma-informed care with adequate training, mentorship, and resources (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The pilot project aimed to evaluate the feasibility, acceptability, and effectiveness of task sharing in GBV care at two health centers in Ethiopia. By demonstrating the potential of task sharing to bridge the GBV care gap, this project offers a scalable model for improving survivor outcomes in Ethiopia and similar low-resource settings.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis pilot project employed an implementation research approach, combining elements of operations research to evaluate the feasibility, acceptability, and early outcomes of a task-sharing model for gender-based violence (GBV) care in primary health care settings. The project aimed to integrate GBV services into routine health care by empowering mid-level, non-physician providers to deliver first-line medical and psychosocial care and facilitate legal support.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and baseline assessment\u003c/h3\u003e\n\u003cp\u003e The baseline assessment was carried out by St. Paul Institute for Reproductive Health and Rights (SPIRHR), the project owner, across six health centers under the Addis Ababa City Administration and Oromia Regional State during June 2022. The facilities included Afincho Ber, Kotebe, and Saris in Addis Ababa, as well as Alemgena, Sebeta, and Burayu in Oromia. The primary objective was to evaluate the existing service landscape and identify suitable sites for pilot implementation. A structured checklist was used to assess each facility\u0026rsquo;s readiness to provide GBV services, covering four key domains: background information, physical infrastructure, human resources, and service delivery components. Interviews were conducted with facility heads to gauge management commitment and perspectives on decentralizing GBV care. Self-reported information was verified through direct observations by the project coordinator.\u003c/p\u003e \u003cp\u003eFindings revealed that while all centers expressed readiness and had taken initial steps, such as allocating rooms and initiating staff training, critical gaps remained. Most centers lacked dedicated spaces for psychosocial care, social workers, or waiting areas. Although all had examination rooms and toilets, only a few had spaces for investigations. Human resource capacity varied, with staff ranging from 4 to 30 per facility. Only three of the six centers had staff with prior GBV training (nine individuals in total). Documentation of GBV cases was inconsistent. Overall, while there was the commitment to provide GBV services, readiness was limited by insufficient infrastructure, inconsistent service documentation, and a lack of trained personnel.\u003c/p\u003e \u003cp\u003e A project launching workshop was held with the participation of key stakeholders, including representatives from the Oromia Regional Health Bureau, Addis Ababa City Administration Health Bureau, Federal Ministry of Health, Ministry of Justice, the heads of the two participating health centers, and representatives from both the Oromia and Addis Ababa Police Commissions. During the workshop, inputs were gathered to inform the implementation of the project. The representative from the Ministry of Justice presented on the current status of one-stop center establishment and the Ministry\u0026rsquo;s role in supporting GBV response. Additionally, officials from the two regional health bureaus shared updates on the existing GBV care services and reaffirmed their commitment to supporting the project.\u003c/p\u003e\n\u003ch3\u003eProject implementation\u003c/h3\u003e\n\u003cp\u003eBased on the baseline findings, two model sites were selected for the pilot: Afincho Ber Health Center (Addis Ababa) and Burayu Health Center (Oromia). Selection was based on caseload volume, available infrastructure, and leadership commitment. The health center management teams identified and assigned mid-level, non-physician providers to participate in the project. Fourteen healthcare providers (3 males, 11 females), including Health Officers (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), Midwives (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and Nurses (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), were trained in comprehensive GBV management with practical attachment in two one-stop centers in Addis Ababa (Tirunesh Bejing and Ghandi Memorial Hospitals).\u003c/p\u003e \u003cp\u003eThe initial training lasted two weeks and covered:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSurvivor-centered care and psychosocial first aid;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGBV-related history taking and physical examination;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClinical management, including emergency contraception, PEP, and STI prophylaxis;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMedico-legal documentation and preparation of medical certificates for legal use.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eA five-day refresher training was conducted midway through the implementation period to reinforce key skills and address practical challenges identified during service delivery. In addition, three mid-level providers with prior experience in GBV care were newly engaged from Burayu Health Center to strengthen the team. Pre and post-training assessments were conducted to evaluate participants\u0026rsquo; knowledge and core competencies in GBV care. The average post-test score was 92%, with individual scores ranging from 85\u0026ndash;95%, indicating strong comprehension and skill acquisition following the training.\u003c/p\u003e \u003cp\u003eThe selected health centers were equipped with essential medical supplies and equipment needed to provide GBV care. Ongoing clinical mentorship was provided by senior gynecologists and obstetricians from St. Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC), supported by a WhatsApp group for real-time case discussions.\u003c/p\u003e \u003cp\u003eReferral linkages were established with SPHMMC\u0026rsquo;s Departments of Obstetrics \u0026amp; Gynecology and Forensic Medicine for cases requiring advanced clinical or forensic care.\u003c/p\u003e \u003cp\u003eTo enhance legal system integration, a one-day sensitization and training session was conducted for four police officers and three public prosecutors, led by an experienced legal expert specializing in GBV cases.\u003c/p\u003e \u003cp\u003eCommunity awareness was also prioritized. Through collaboration with existing urban and rural health extension programs, the project conducted advocacy sessions to inform community leaders and residents about the availability of GBV services at the pilot sites. A total of 65 community members participated in a dedicated one-day advocacy event.\u003c/p\u003e \u003cp\u003eThe project was effectively implemented over a one-year period between June 2022 and July 2023, although the total duration of the pilot extended slightly beyond one year. Two no-cost extension periods were granted due to unforeseen challenges beyond SPIRHR\u0026rsquo;s control.\u003c/p\u003e\n\u003ch3\u003eData sources\u003c/h3\u003e\n\u003cp\u003eMultiple data sources were used to inform the evaluation of the pilot. These included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRoutine service delivery data and patient registers are maintained at the health centers;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStructured facility assessment checklists;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQualitative feedback collected through interviews with health center managers and community stakeholders;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEndline client phone satisfaction interviews and a stakeholder consultation workshop\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eKey indicators and outcome measures\u003c/h3\u003e\n\u003cp\u003eKey process and outcome indicators included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePerceived readiness and capacity of health facilities;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNumber and profile of GBV survivors receiving care;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTypes of GBV encountered and timeliness of presentation;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eServices provided (laboratory tests, emergency contraception, PEP, injury care, referrals, and legal linkages);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProportion of survivors receiving comprehensive GBV care;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUser satisfaction was assessed using a 19-item Likert-scale questionnaire, in which service users rated each item on a five-point scale: \u0026ldquo;strongly disagree\u0026rdquo;, \u0026ldquo;disagree\u0026rdquo;, \u0026ldquo;uncertain\u0026rdquo;, \u0026ldquo;agree\u0026rdquo;, and \u0026ldquo;strongly agree\u0026rdquo;.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStakeholder perceptions on scalability and sustainability\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The project protocol was reviewed and approved by the Civil Society Coordination team of the Partnership and Cooperation Directorate at the Federal Ministry of Health, Ethiopia. Ethical clearance was granted following a thorough review and incorporation of comments from the Ministry. All participant feedback and data collection activities respected principles of confidentiality, voluntary participation, and informed consent.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGBV case load and survivor profiles\u003c/h2\u003e \u003cp\u003e Over the one-year pilot implementation period, a total of 45 survivors of gender-based violence (GBV) received care at the two pilot health centers: 16 (35.6%, n\u0026thinsp;=\u0026thinsp;16/45) at Afincho Ber (Addis Ababa City Administration) and 29 (64.4%, n\u0026thinsp;=\u0026thinsp;29/45) at Burayu Health Center (Oromia Regional State). Nearly half of the survivors, 22 (48.9%, n\u0026thinsp;=\u0026thinsp;22/45), were under the age of 18. The vast majority were female (97.8%, n\u0026thinsp;=\u0026thinsp;44/45), with only one male survivor (2.2%, n\u0026thinsp;=\u0026thinsp;1/45). Regarding educational status, 23 (51.1%, n\u0026thinsp;=\u0026thinsp;23/45) had completed elementary education, while 8 (17.8%, n\u0026thinsp;=\u0026thinsp;8/45) were unable to read and write. Most survivors were single (82.2%, n\u0026thinsp;=\u0026thinsp;37/45), and 26 (57.8%, n\u0026thinsp;=\u0026thinsp;26/45) were students (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNature and pattern of violence\u003c/h2\u003e \u003cp\u003eThe majority of GBV cases involved sexual violence (66.7%, n\u0026thinsp;=\u0026thinsp;30/45), followed by physical violence (17.8%, n\u0026thinsp;=\u0026thinsp;8/45), and mixed forms (15.6%, n\u0026thinsp;=\u0026thinsp;7/45). The most commonly reported perpetrators were intimate partners (44.4%, n\u0026thinsp;=\u0026thinsp;20/45), followed by family members (22.2%, n\u0026thinsp;=\u0026thinsp;10/45) and strangers (22.2%, n\u0026thinsp;=\u0026thinsp;10/45). Attempted rape was reported by 11 survivors (24.4%, n\u0026thinsp;=\u0026thinsp;11/45), while 25 (55.6%, n\u0026thinsp;=\u0026thinsp;25/45) experienced forced rape. Ten (22.2%, n\u0026thinsp;=\u0026thinsp;10/45) of the survivors reported a history of rape by the same perpetrator. Fresh physical injuries such as tears and bruises were observed in 17 survivors (37.8%, n\u0026thinsp;=\u0026thinsp;17/45).\u003c/p\u003e \u003cp\u003eTimeliness of care-seeking was generally favorable in which 66.7% (n\u0026thinsp;=\u0026thinsp;30/45) of survivors arrived within three days of the incident, which is considered the optimal window for forensic evidence collection and for initiating emergency clinical interventions such as post-exposure prophylaxis (PEP) and emergency contraception (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eService utilization and clinical management\u003c/h2\u003e \u003cp\u003eUpon presentation at the health centers, survivors received a range of laboratory investigations. HIV testing was conducted for 43 (95.6%, n\u0026thinsp;=\u0026thinsp;43/45), pregnancy tests for 34 (75.6%, n\u0026thinsp;=\u0026thinsp;34/45), HBsAg testing for 32 (71.1%, n\u0026thinsp;=\u0026thinsp;32/45), and VDRL testing for 31 (68.9%, n\u0026thinsp;=\u0026thinsp;31/45). Emergency contraception and PEP for HIV were each provided to 21 (46.7%, n\u0026thinsp;=\u0026thinsp;21/45) of the eligible survivors, while STI prophylaxis was given to 20 (44.4%, n\u0026thinsp;=\u0026thinsp;20/45).\u003c/p\u003e \u003cp\u003ePsychosocial first-line support was provided to 42 (93.3%, n\u0026thinsp;=\u0026thinsp;42/45), and standard treatment for injuries was administered to 40 (88.9%, n\u0026thinsp;=\u0026thinsp;40/45). Legal service linkage was established for 38 survivors (84.4%, n\u0026thinsp;=\u0026thinsp;38/45). While health centers previously referred all GBV cases to hospitals for further care, during the pilot period, only 3 (6.7%, n\u0026thinsp;=\u0026thinsp;3/45) cases were referred: 2 from Afincho Ber and 1 from Burayu (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eClient satisfaction and perceived quality of care\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTo assess client satisfaction and perception of service quality 73.3% (n\u0026thinsp;=\u0026thinsp;33/45) of survivors (12 from Afincho Ber and 21 from Burayu) participated in a telephone interview conducted by trained healthcare providers not directly involved in their care. The majority of respondents either \u0026ldquo;agreed\u0026rdquo; or \u0026ldquo;strongly agreed\u0026rdquo; to all positive statements related to service accessibility, quality, provider communication, respect, and affordability. For example, 100% of survivors from Afincho Ber and 90.5% from Burayu indicated they were satisfied with the GBV care received. Survivors also reported high levels of trust in health providers and perceived the care environment as respectful and supportive (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eStakeholder perspectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA stakeholder consultation workshop was conducted involving 16 participants, including healthcare providers, representatives from the Ministry of Justice and Addis Ababa Police, and health bureau officials from both regions. The consultation revealed a broad consensus on the importance and feasibility of decentralized GBV care delivery. Seventy-five percent of participants recommended scaling up the task-sharing model to other parts of the country, particularly underserved areas, as a sustainable strategy for improving GBV care access and responsiveness (data not shown).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral socio-demographic characteristics of the GBV survivors managed at the two health centers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber per facility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfincho Ber HC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurayu HC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of the beneficiaries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status of the beneficiaries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior secondary/Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege/University education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent marital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommercial sex worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eType of perpetrators and pattern of gender-based violence experienced by the survivors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePattern of GBV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerpetrator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntimate partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStranger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCustomer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeighbor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCo-worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual Violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of days after the incident\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimely arrival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLate arrival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of rape\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy the same person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo past history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of rape\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttempted rape\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcquaintance rape\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForced rape\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of fresh tear, bruise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCare provided by the non-physician care providers after the GBV survivors presented to the health centers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAction taken at the health center*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLab tests done\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVDRL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBsAg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevention of STI and pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePEP for HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTI prophylaxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment provided\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-line support given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard treatment of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegal service linkage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferral to the hospital for additional care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003eThe percentages do not add up to 100%\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerception of the GBV services users about the GBV care provided at Afinicho Ber and Burayu Health Ceners on a Liker Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e*Afinicho Ber Health Centre\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e*Burayu Health Centre (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrongly Agree (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAgree (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStrongly Agree (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth professionals explain medical tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe GBV unit has essential care resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe GBV care received is just about perfect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProviders offer psychosocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCan get GBV care without financial setback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProviders ensure thorough treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGBV care is affordable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccess to medical specialists when needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWait time for GBV care is reasonable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated with dignity and respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService is friendly and courteous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProviders address concerns adequately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProviders listen to patients concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe center provides all GBV services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasy to get a GBV appointment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied with the GBV care received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to get medical care when needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCan access legal services when needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*NB: The questionnaire was administered by interviewers, and service users did not respond with \u0026ldquo;Disagree\u0026rdquo; or \u0026ldquo;Strongly disagree\u0026rdquo; to any items at Afincho Ber HC, nor with \u0026ldquo;Uncertain,\u0026rdquo; \u0026ldquo;Disagree,\u0026rdquo; or \u0026ldquo;Strongly disagree\u0026rdquo; at Burayu HC. Hence, these response categories are intentionally omitted from the table for clarity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis project demonstrated that task sharing in the provision of gender-based violence (GBV) care at the primary health care level is feasible, acceptable, and effective in improving access to essential services. By training and equipping mid-level non-physician providers, the two model health centers successfully managed a good number of cases over one year, with the majority of survivors receiving comprehensive clinical and psychosocial care, as well as legal service linkage without a need to referral to a higher facility. Most survivors presented within the optimal timeframe for medical and forensic intervention, and over 90% reported high satisfaction with the care received. Importantly, less than 10% of cases required referral to higher-level hospitals, demonstrating the capacity of trained mid-level non-physician providers to manage GBV cases locally and reduce the burden on tertiary facilities.\u003c/p\u003e \u003cp\u003eThese findings of this project align with growing evidence supporting task sharing as a strategy to expand access to essential health services in low-resource settings (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A study that explores the status, successes, challenges, and impacts of the implementation of task sharing for family planning in five sub-Saharan African countries, including Ethiopia, reported increased contraceptive uptake through task sharing to midwives and community health workers, with family planning users rising substantially (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Similarly, the study on tubal ligation service delivery in Ethiopia found that health officers trained in the procedure maintained high protocol adherence (96.9%) and achieved high client satisfaction (98.2%), mirroring the strong quality of care and acceptability observed in our GBV pilot (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In mental health, the task-shared care for people with severe mental disorders (TaSCS) trial in Ethiopia demonstrated that task-shared care delivered by non-specialists was not inferior to specialist-led care and was cost-effective, an important consideration for scaling GBV services sustainably (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe emphasis on comprehensive training and mentorship in our pilot project addresses concerns raised by other task-sharing models regarding variability in non-specialist training and safety (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In our context, a structured two-week training, followed by refresher sessions and ongoing specialist mentorship, helped ensure quality and built provider confidence. The high satisfaction levels reported by GBV survivors in our study further underscore the importance of well-designed training and support systems for successful task-sharing initiatives.\u003c/p\u003e \u003cp\u003eOne of the key strengths of this pilot project was its successful demonstration of the feasibility and acceptability of task-sharing for GBV care within the primary health care system. By equipping and mentoring mid-level, non-physician providers, the project enabled the delivery of integrated clinical, psychosocial, and legal services at the community level. The fact that two-thirds of survivors presented within 72 hours, the critical window for effective medical and forensic intervention, reflects improved access and responsiveness of the decentralized model. Importantly, the vast majority of cases were managed entirely at the health center level, with only minimal referrals to higher-level hospitals, illustrating the capacity of trained providers to handle GBV cases effectively within primary care settings when supported with the appropriate resources and supervision (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe structured, hands-on training, complemented by continuous mentorship from specialists at SPHMMC, proved essential in enhancing provider confidence and clinical decision-making. A dedicated communication platform allowed for timely consultation, contributing to the quality and consistency of care. Client feedback further validated the success of the model, with over 90% of survivors reporting satisfaction with the care received, particularly in terms of provider communication, respect, privacy, and accessibility. The integration of legal services into the care pathway and the engagement of local law enforcement and prosecutors underscored the value of multi-sectoral collaboration in delivering a coordinated GBV response. The endorsement of the model by the majority of stakeholders, who recommended its expansion to additional sites, indicates strong support for the broader institutionalization of this approach within the health system.\u003c/p\u003e \u003cp\u003eWhile the pilot was implemented in only two health centers and involved a relatively modest number of survivors, the insights gained are nonetheless valuable for informing the scale-up of similar initiatives. Some challenges related to physical infrastructure and structured follow-up of provider performance were noted; however, these are common to many implementation efforts in low-resource settings and can be addressed through ongoing system strengthening. Lastly, client follow-up was conducted via phone interviews, which may have introduced response bias, especially considering the sensitive nature of GBV experiences. Despite these considerations, the pilot offers compelling evidence for the viability of task-sharing in expanding access to high-quality GBV care in primary health care settings.\u003c/p\u003e "},{"header":"Conclusion and lessons learned","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003cp\u003eThis pilot project demonstrated that comprehensive, survivor-centered GBV care can be effectively delivered at the primary health care level through task sharing. By equipping and mentoring mid-level, non-physician providers, health centers were able to offer timely and integrated medical, psychosocial, and legal services to GBV survivors, services that are traditionally limited to higher-level facilities. The successful implementation at Afincho Ber and Burayu health centers provides promising evidence that decentralizing GBV care is not only feasible but also acceptable to both providers and survivors.\u003c/p\u003e \u003cp\u003eKey lessons emerged from the one-year proof-of-concept implementation:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTask sharing in GBV care is feasible and effective when non-physician providers are adequately trained, supported through continuous mentorship, and provided with the necessary infrastructure and supplies. This approach can significantly reduce the burden on hospital-based services while maintaining the quality of care.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDecentralized care at health centers brought services closer to survivors, enabling more timely medical evaluation, emergency interventions (such as PEP and emergency contraception), and linkages to legal support.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCoordinated legal support at the health center level facilitated timely documentation of injuries and issuance of medico-legal certificates, strengthening survivors\u0026rsquo; access to justice while reducing the logistical and financial burden of seeking care across multiple institutions is achievable.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSurvivors consistently reported positive experiences related to the quality of care, provider communication, privacy, and trust, highlighting the importance of respectful, accessible, and integrated services at the community level.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eGBV\u003c/strong\u003e\u0026nbsp; Gender-based violence\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEDHS\u003c/strong\u003e Ethiopia Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePEP\u003c/strong\u003e\u0026nbsp; Post-exposure prophylaxis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTI\u003c/strong\u003e\u0026nbsp; Sexually transmitted infection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBsAg\u003c/strong\u003e\u0026nbsp; Hepatitis B surface antigen\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVDRL\u003c/strong\u003e Venereal Disease Research Laboratory\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNPP\u003c/strong\u003e\u0026nbsp; Non-physician providers\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPHMMC\u003c/strong\u003e\u0026nbsp; \u0026nbsp;St. Paul\u0026rsquo;s Hospital Millennium Medical College\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHC\u003c/strong\u003e Health center\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMOH\u003c/strong\u003e Ministry of Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePHC\u0026nbsp;\u003c/strong\u003ePrimary health care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTaSCS\u003c/strong\u003e Task-Shared Care for Severe Mental Disorders\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPIRHR\u003c/strong\u003e St. Paul Institute for Reproductive Health and Rights\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSA\u003c/strong\u003e Sub-Saharan Africa\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSt. Paul Institute for Reproductive Health and Rights gratefully acknowledge the healthcare providers and CEOs at Afincho Ber and Burayu Health Centers for their facilitation and dedicated care of GBV survivors. We thank Gynecologists, Obstetricians and Forensic specialist at St. Paul\u0026apos;s Hospital Millennium Medical College for their clinical mentorship and training of providers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe appreciate the Federal Ministry of Health, Oromia Regional Health Bureau, and Addis Ababa City Administration Health Bureau for their policy support, and facilitation of project activities, and the Ministry of Justice and Addis Ababa, and Oromia Police Commissions for their collaboration in strengthening legal linkages for survivors. Community leaders and health extension workers were instrumental in awareness efforts. Most importantly, we thank the survivors who shared their experiences, motivating our work to expand survivor-centered care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was made possible through the generous support of Grand Challenges Canada [Grant #: \u0026nbsp;ST-POC-2205-52311]. The views expressed in this manuscript are those of the authors and do not necessarily reflect the official position of the supporting institutions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKedir A, Admasachew L (2010) Violence against women in Ethiopia. Gender, Place \u0026amp; Culture [Internet] Routledge; ;17:437\u0026ndash;52. 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Health Policy Plan 32:163\u0026ndash;169\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanlon C, Medhin G, Dewey ME, Prince M, Assefa E, Shibre T, Ejigu DA, Negussie H, Timothewos S, Schneider M et al (2022) Efficacy and cost-effectiveness of task-shared care for people with severe mental disorders in Ethiopia (TaSCS): a single-blind, randomised, controlled, phase 3 non-inferiority trial. Lancet Psychiatry 9:59\u0026ndash;71\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshengo T, Skeels A, Hurwitz EJH, Thuo E, Sanghvi H (2017) Bridging the human resource gap in surgical and anesthesia care in low-resource countries: a review of the task sharing literature. Hum Resour Health 15:77\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSidat MM (2016) Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems? Comment on Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians. Int J Health Policy Manag Iran 5:725\u0026ndash;727\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"St. Paul Institute for Reproductive Health and Rights","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":"Gender based violence, task-sharing, non-physician providers, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6748476/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6748476/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGender-based violence (GBV) is a pervasive public health and human rights issue in Ethiopia, characterized by high prevalence and limited access to care. Systemic barriers, including stigma, a shortage of trained providers, and the centralization of services in hospitals located in major cities, significantly hinder timely support for survivors. Care is typically delivered by a small number of gynecologists and obstetricians, further constraining access. This pilot project aimed to evaluate the effectiveness of task sharing, delegating GBV care to trained non-physician providers, in addressing these gaps at two health centers in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis pilot project employed an implementation research approach to evaluate the operational and technical feasibility and effectiveness of task sharing in GBV care at two health centers in Ethiopia. Fourteen mid-level providers (health officers, midwives, and nurses) received comprehensive training in medical evaluation, psychosocial support, and legal referrals. The project included baseline facility assessments, structured training, ongoing mentorship, and community engagement. Data were collected through service records, client satisfaction interviews, and stakeholder consultations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver one year, 45 survivors of GBV received comprehensive care, with 66.7% presenting within 72 hours of the incident. Sexual violence was the most frequently reported form, accounting for 66.7% of cases. Trained providers delivered key services, including HIV testing (95.6%), emergency contraception and post-exposure prophylaxis for HIV (46.7%), sexually transmitted infection prophylaxis (44.4%), and psychosocial support (93.3%). Legal service linkages were established for 84.4% of survivors, and only three cases (6.7%) required referral to higher-level facilities. Client satisfaction was high, with over 90% of respondents reporting positive care experiences. Stakeholders expressed strong support for scaling up the intervention. These findings underscore the effectiveness of the task-sharing approach in expanding access to essential, survivor-centered GBV care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and lessons learned\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTask sharing proved feasible and effective in decentralizing GBV care, improving accessibility, and reducing referral burdens. Key lessons include the importance of structured training, continuous mentorship, and multi-sectoral collaboration. This model offers a scalable solution to enhance GBV care in low-resource settings.\u003c/p\u003e","manuscriptTitle":"Improving access to care for survivors of gender-based violence through task sharing with non-physician providers in Ethiopia: experience from a pilot project","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-29 11:45:56","doi":"10.21203/rs.3.rs-6748476/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":"fba85cc7-0187-4f8f-8cde-ad693523af0e","owner":[],"postedDate":"May 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":49039464,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2025-05-29T11:45:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-29 11:45:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6748476","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6748476","identity":"rs-6748476","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}