improving the collection, documentation and utilization of

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Improving the collection, documentation and Improving the collection, documentation and utilization of medicoutilization of medico--legal evidence in Kenyalegal evidence in Kenya

Carol AjemaCarol Ajema, Wanjiru Mukoma, Wanjiru Mukoma

2828thth March 2013March 2013

44thth EAC Health & Scientific ConferenceEAC Health & Scientific ConferenceKigaliKigali

• Ad hoc collection of evidence collection from survivors in Kenya :– Many health facilities lack equipment required to

undertake evidence collection

• Required documentation for survivors of SV reporting at health facilities and police:

– PRC form: health document for medico-legal documentation

– P3 form: Kenya police medical examination form

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Study Background

• Duration:2010-Jan 2012• Sites: 2 districts• Target population: Police and health care

workers• How:

– Record review-baseline & end line

– Assembling rape kit;

– Training Police and health providers on use of

existing national protocols

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Chain of Evidence Study

Study Collaborators

• Ministry of Health-

– Division of Reproductive Health

– Government Chemist

• Office of the Director of Public Prosecution

• Police Department

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Key Findings• 67%(n=501) of survivors were under 18years

– 331 survivors attended to at intervention site– 170 comparison site

• Survivors at the intervention site were three times more likely to have the Kenya police (P3) form filled in for them both at the health facility and police station

• PRC forms not filled in for all survivors– Incomplete forms- names, age, gender, examining health

provider information?• Only 17% of P3 forms at the facilities were signed 55

Key Findings• There was an improvement in evidence collection

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Evidence collected

Baseline Data Endline Data

Intervention site

Comparison site

Intervention site

Comparison site

BloodUrine

External Swabs

HVS/AS

73 (72%)52 (51%)61 (60%)

-

8 (18%)8 (18%)1 (2%)

5 (11%)

206 (96%)154 (72%)19 (9%)

176 (82%)

38 (37%)38 (37%)3 (3%)

14 (42.4%)

Findings• The rape kit was found useful

“The biggest problem in hospitals is that the supply of some of these things {commodities required to

retrieve evidence} is not sufficient. …… That’s why I find this {rape kit} so convenient. Because im able to collect evidence and attend to a survivor in a very

short time”Health provider

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• The introduction of the rape kit that resulted in:– Faster evidence collection and onward transmission

• Overall increase in use of and better completion of the medico-legal forms(PRC & P3)

• The rape kit reduced the number of reference documents required to complete the PRC form

• The rape kit can easily and effectively be used to improve evidence collection and documentation in poor resource settings - can be scaled up

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Conclusion

Application of study findings Application of study findings

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National level advocacy• PRC form and PRC registers reviewed based on findings

• Ministry of Health – sourcing for rape kits within the GoK commodity supply

system- scale up– National guidelines reviewed

• Medical regulations for implementing the sexual offences Act requiring:

– Doctors, nurses and clinical officers to fill in the PRC forms– PRC form now recognised as legal document

Application of study findings Application of study findings At the service delivery level• A multi-sectoral training approach adapted by the sexual

offences Act implementation taskforce

Documentation :– IECs developed adapted by the Ministry of Health

• a checklist on documentation of evidence collection• A brochure and poster on “sexual violence if it happens”• A poster on guidelines for documentation of medico-legal

examinationPRC register developed:

– Health providers to record at least THREE names of survivors 1010

Moving forward..….

1313Building Partnerships, transforming lives

• Advocacy continues for– Acceptance of rape kit evidence as credible– Serialisation of the rape kit components

• Replication of the multi-sectoral training approach in scaling up Kenya’s response to sexual violence

• What services do we provide to survivors presenting after 72 hours? – No standards– Currently getting full PEP– No consistency of services

Moving forward..….


• Future research:– paper trail of medico-legal evidence-esp. police

records– Case outcomes within the courts based on health

and police records

• Interventions required:– Role of community structures(traditional justice

system preferred by most) in evidence chain management

PROJECT : the research-policy-practice interface

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COE 2COE 2––2010 2010 --20122012--Utilization of Utilization of documentation documentation

COE1: 2007 COE1: 2007 --2008 2008 Design, test model for Design, test model for a chain ofa chain of evidence evidence for PRCfor PRC

--Poor medicoPoor medico--legal linkages; legal linkages; no standards & chain of no standards & chain of evidenceevidence

Effectiveness of PRC kit for Effectiveness of PRC kit for improved justice outcomes improved justice outcomes unknownunknown

20011/12: 20011/12: -- Review of Review of algorithms; IEC, algorithms; IEC, Inclusion of rape kit Inclusion of rape kit into guidelines)into guidelines)

2008/9: 2008/9: -- Review of Review of guidelines (chapter on guidelines (chapter on forensic evidence)forensic evidence)--Review of PRC formReview of PRC form

Thank You!Thank You!

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Carol [email protected]

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LVCT LVCT –– an indigenous Kenyan NGOan indigenous Kenyan NGO

• Quality Assured HIV testing and counselling (HTC) & links to Rx

• Vulnerable & at risk populations:• MSM/Prisons; Disability; Youth

;Sex workers; Survivors of SV• Evidence based policy reforms

• National standards; systems strengthening; scaling up

• South to south TA guidelines for HTC,QA,&PRCa

Acknowledgements


• Population Council • Ministry of Health –Division of Reproductive

Health• The Government Chemist• The Police Department• Donors(SIDA,NORAD)• Study respondents

Acronyms


• DRH Division of Reproductive Health• PRC Post Rape Care• LVCT Liverpool VCT, Care & Treatment

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