Innovations, lessons learned and good practices

Lesotho: Strengthening Child Protection Services for Survivors of Sexual Abuse

Issue addressed

With an HIV prevalence rate of 23 per cent among adults aged 15–49, Lesotho is the third hardest hit country in the world, according to figures from the Government of Lesotho and UNAIDS. Life expectancy has declined precipitously as a result, from 60 in 1991 to 35 in 2006. This has been accompanied by a dramatic increase in the number of orphaned children, from an estimated 73,000 in 2001 to an estimated 180,000 today, of which 100,000 are thought to have lost both parents to the epidemic. Some 142,000 orphaned children are registered in the school system, although 30 per cent of school-age children, mostly girls, have dropped out to care for ailing family members. Information from the Ministry of Health and Social Welfare (MoHSW) and from media and police reports indicates that orphaned children are more vulnerable to all forms of abuse, neglect and violence, whether at home, in school or in the community at large. Deprived of care, many are also forced into early marriage, commercial sex work, living and/or working on the streets, substance abuse and petty crime.

Within this context, reported incidents of rape have increased in the past five years. Such cases include children of all ages, with the highest number in the 13- to 18-year age group. In recent times, however, an increasing number of cases of rape have been reported involving young children and infants as young as 12 months. The increased reporting is attributed to greater community awareness of the Sexual Offences Act of 2003 and by the formation, that same year, of a new Child and Gender Protection Unit (CGPU) within the police administration. The CGPU, which has branches in all 11 police districts countrywide, deals with crimes against women and children, especially abuse and domestic violence. In 2005, out of 668 cases reported to the CGPU, 339, or 51 per cent, were sexual offences, and of these, 166 involved children under the age of 18. Between January and June 2006, 789 sexual offence cases were reported, of which 179 involved children (see table below).

Sexual Offences Reported 2003 to 2006, by Age and Gender

 

2003

2004

2005

2006*

Age group (yrs)

Girls

Boys

Girls

Boys

Girls

Boys

Girls

Boys

0 – 6

15

0

6

0

10

0

9

0

7 – 12

9

1

19

0

20

0

19

0

13 – 18

73

1

130

0

136

0

151

0

Total

97

2

155

0

166

0

179

0

Source: Child and Gender Protection Unit – Lesotho Mounted Police Service (2006)
*Covers period January to June 2006

Given the high prevalence of HIV and the very real risk of its transmission to children in such cases, rape and sexual abuse are not just issues of child protection but also of child survival. It is consequently necessary to link the reporting of these cases to timely and effective services in order to ensure that children who have undergone such an experience are treated sensitively and that they have access to post-exposure prophylaxis (PEP) to prevent HIV infection. Unfortunately, a closer look at the handling of these cases reveals significant gaps in the technical knowledge of health staff and other service providers who care for survivors of rape, particularly children.

For instance, among the challenges highlighted by CGPU staff was the lack of support from medical doctors, many of whom are reluctant to make police reports or give evidence in court (in many cases, because they are foreigners, rather than Lesotho natives). This makes it difficult for prosecutors and magistrates to convict perpetrators of sexual offences and seriously inhibits the quality and type of treatment provided to rape survivors.

Strategy used and actions taken

Because accurate data on the incidence of sexual abuse is critical to preventing these crimes, UNICEF, in 2005–2006, supported the development of a computerized database of reported children’s and women’s sexual abuse cases. This was done as part of UNICEF’s ongoing capacity-building support for the police’s Child and Gender Protection Unit at both national and district levels, other aspects of which support include in-depth orientation on child protection issues and the pertinent legal and policy framework, psychosocial care and support techniques and stress management. The database was piloted in Maseru district at the end of 2005 and then rolled out to selected police districts, with training provided to CGPU staff on its use. Hand-in-hand with this training and with database development went awareness-raising by the CGPU at the community level.

The database aims to capture details of cases as they are reported and to make accurate, updated data available at all times to service providers and senior policy makers to keep them informed of the magnitude of the problem. It also aims to improve referral links between the police and the social welfare, health and judicial systems, thus ensuring that survivors are treated sensitively and receive the quality services due them.

The gaps in treatment and care for survivors of sexual abuse noted above – for instance, the reluctance of many medical doctors to treat them, to report cases to the police or give evidence in court – led to the development of national Guidelines for the Management of Survivors of Sexual Abuse. Adapted for Lesotho from the WHO Protocols for Sexual Abuse, the guidelines support the implementation of the Sexual Offences Act of 2003 and provided the basis for passage of the Child Protection and Welfare Bill. 

The main objective of the national guidelines is to ensure proper and effective management by all sectors that have responsibilities in handling cases of sexual abuse, as follows:

  • Enhance effective service provision through a comprehensive and integrated approach towards managing sexual abuse;
  • Ensure that appropriate emergency (Post-Exposure-Prophylaxis) and medical treatment and psychosocial care and support are provided at a health centre facility;                 
  • Enhance the legal system's ability to protect survivors and prosecute perpetrators in accordance with the existing legal framework;
  • Develop and strengthen referral mechanisms within the key sectors involved in dealing with the survivor at all levels.

The process of adapting the guidelines was led by the Family Health Division of the Ministry of Health and Social Welfare (MoHSW), with UNICEF’s support. They were drafted by members of the police CGPU and other agencies participating in the handling of sexual abuse survivors or in prosecuting the perpetrators.

In October 2006, a training of trainers (ToT) session on the finalized guidelines was conducted by the MoHSW with technical assistance from Family Support Trust, a Zimbabwe-based NGO that specializes in the treatment of sexually abused children. Participants were 47 staff members, mainly from the health sector, but also from social welfare, the police, and NGOs.

Following the ToT, the MoHSW conducted four regional training workshops on the guidelines, covering all districts in the country. Most of the 200 participants were service providers, including medical doctors and health centre nurses, as well as some magistrates and prosecutors. Their participation was considered crucial, given the history of complaints about the inadequate and insensitive examination of sexual abuse survivors by medical practitioners, their inaccurate completion of forms and their reluctance to deal with the courts to give evidence.

In compliance with the guidelines, the Ministry of Health and Social Welfare also issued a memo instructing government hospitals and health centres to provide free medical treatment to survivors of sexual abuse. The instruction took effect immediately, so as to encourage more survivors to seek services without delay.

Results

A key result of the actions described above was the increased reporting of sexual abuse cases to the CGPU in 2006 compared with previous years, and the inclusion of this valuable information in the database. While it is too early to provide precise data on the impact of the training sessions, some qualitative improvements were reported to have taken place in a very short time. The CGPU indicates that it has become easier to obtain treatment for rape survivors by doctors and staff at public health facilities, that there is more collaboration among the police, courts, hospitals and social workers, that more cases have been reported by communities, prosecuted and convicted and that there is greater clarity about the roles of the individual sectors. Most importantly, service providers are referring cases and dealing with them according to the guidelines, particularly in the districts outside the initial Maseru pilot district.

Government and NGO staff continue to be trained on the new guidelines and their policy framework, creating awareness among communities, survivors and service providers. For example, in Thaba Tseka district, a doctor at a public hospital indicated that before the training, he had not been aware of some of the signs of rape, but that he is now able to identify sexually abused children and has developed stronger referral links with the social welfare system and district police. He sometimes asks the hospital to keep survivors for a few days to enable CGPU to investigate the case. CGPU staff in all districts have been trained to provide psychosocial care and support, particularly through play therapy for children and in some cases counselling.

Lessons learned

The lessons learned in this programme are threefold. First, the collection and analysis of data on the incidence of sexual abuse of children is crucial and forms the basis for all further interventions. There is a need for continued analysis of child rape and sexual abuse data from the CGPU database, disaggregated by sex, age, and other factors, so as to provide updated information to government and development partners that can be used to raise awareness of the sexual abuse problem and help target budget allocations to the districts. Continued awareness-raising with communities regarding the importance of reporting sexual offences quickly is also needed.

Second, sexual abuse should be considered a health issue, not simply a child protection issue. In Lesotho, all agencies need to support the integration of sexual abuse into maternal and child health (MCH) or primary health care (PHC) interventions, so it can be handled appropriately in clinical settings. This is especially important in a country where the incidence of child rape is increasing and HIV prevalence is high, posing serious risks of transmitting the infection to the child.

Finally, mitigation of sexual abuse and treatment of survivors must be a collaborative effort among agencies and government sectors, not the sole responsibility of one. Because lack of communication between sectors is one of the main reasons why survivors of rape often fall through the cracks or are further traumatized within the system, cross-sectoral collaboration and communication should be improved to take advantage of positive reinforcement. For instance, training of health staff along with magistrates and prosecutors enables each to understand the problems faced by the other and facilitates referrals. There is also a need to conduct such training on an annual basis to ensure that new doctors are aware of the guidelines and equipped to handle the situations they will encounter appropriately.

Remaining Challenges

Several challenges remain to be addressed:

  • Ensuring the correct completion of forms by doctors who provide free services to survivors in hospitals and health centres.
  • Ensuring that health staff give priority to treatment of cases of rape, understanding its implications for children in an area of high HIV prevalence.
  • Providing a conducive environment and adequate facilities in which to treat survivors of rape (privacy, space, availability of PEP, and so on).
  • Strengthening the weak justice system to enforce the necessary legal protection for cases of sexual abuse, especially the sensitive handling of cases of child abuse by all concerned.
  • Strengthening the limited psychosocial care and support system for the survivors, since even CGPU staff are often confronted with inadequate facilities to practise such skills when required.
  • Providing places of safety, currently seriously lacking, in each of the districts outside Maseru for rape survivors, who often end up being sent back home to the same abusive environment from which they came, with a high risk of repeated abuse.

 

 

New enhanced search