Evaluation of the One Stop Centre Model

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EVALUATION OF THE ONE STOP CENTRE MODEL

Integrated Care for Survivors of Sexual and Gender-Based Violence in Eswatini

A national, internal evaluation reviewing more than a decade of the One Stop Centre (OSC) approach finds a model that works well at first contact — but one whose long-term impact is held back by fragmented financing, incomplete data, and gaps in after-hours care.

WHY THIS MATTERS

Survivors of sexual and gender-based violence  including children, adolescents and persons with disabilities often face repeated retelling of their experience across health, police, justice and social welfare systems. Eswatini's OSC model brings these services together in one place, anchored at hospitals in Mbabane and Manzini, to reduce that burden and speed up the response. This first-ever evaluation, covering 2013 to 2025, draws on 23 key informant interviews, 15 survivor/caregiver interviews, staff focus groups, and a review of routine data and policy.

WHAT IS WORKING

• Survivors are seen quickly, with clinical care, counselling and initial justice steps happening in one visit cutting down on repeated disclosure.
• Mbabane's nurse-led “green sheet” system routes survivors directly to gynaecology, shortening waits and protecting evidence, a practice recommended for Manzini too.
• Stationing prosecutors at the centres shortens early case steps, and most survivors report immediate improvements in wellbeing after first contact.
• The model is well aligned with national law and policy and with international good practice on survivor-centred care.

WHERE THE MODEL IS FALLING SHORT

• Reach is limited to an estimated 7–8% of regional need; Lubombo's centre has been non-operational since 2021 and Shiselweni's is not yet established.
• After-hours coverage is inconsistent: police, prosecutors and social welfare aren't always present at night, so some survivors are missed by the next-day system.
• Financing is fragmented with no consolidated OSC budget; recent donor withdrawals have exposed gaps in psychologists, transport, dignity kits and connectivity.
• Records remain paper-based and procedures are not yet finalised, with no routine tracking of justice outcomes against the 12-month benchmark.
• Access is weakest for survivors far from the two hospitals and for persons with disabilities, who face cost, distance and a lack of standard accommodations.

EVALUATION RATINGS AT A GLANCE

Using the OECD-DAC criteria, the evaluation rated how strongly the evidence supports the OSC model's contribution to results in each area. Ratings reflect contribution not sole attribution based on triangulated qualitative and quantitative evidence.

Efficiency and Sustainability are addressed narratively below, as they centre on financing and systems rather than a single contribution rating.

FOUR LESSONS FROM THE EVIDENCE

1. Coordination shapes the survivor's experience.  Simple daily routines clear intake, minimal retelling, accurate documentation with a centre-held copy, and a short case-progress list reviewed by the team make a measurable difference to care.

2. Book counselling before the survivor leaves.  Scheduling follow-up sessions and confirming transport at first contact  with a next-day call for after-hours cases helps prevent survivors from falling out of the system.

3. Split the roles to keep cases moving.  Keeping the prosecutor focused on the legal case while a dedicated OSC case coordinator manages the register, after-hours linkage and referrals would close a key capacity gap.

4. Strengthen the whole referral network, not just the centre.  Equipping clinics, emergency departments, police and social welfare with a basic first-response routine and a guaranteed next-day link to the OSC extends the model's benefits beyond the two hospital sites.

PRIORITY RECOMMENDATIONS

• Secure predictable, consolidated financing for the full OSC package, including psychologists, transport, supplies and helpline support. (High priority , Government of Eswatini, Royal Eswatini Police Service)
• Finalise and institutionalise cross-sector standard operating procedures, including after-hours duty rosters and next-day linkage from emergency departments and police. (High priority DPMO, line ministries)
• Guarantee after-hours continuity through a simple handover and follow-up call system. (High priority, OSC Site Coordinators, Hospital Matrons, Police, Prosecutors)
• Secure authorised psychology capacity in every region so children's cases are not delayed awaiting court-ready reports. (High priority, Ministry of Health, DPP, Social Welfare)
• Extend Mbabane's direct gynaecology routing to Manzini and strengthen evidence handling with secure storage and a chain-of-custody log. (High priority, Hospital management, Police, Prosecutors)
• Standardise inter-agency case tracking, including a disability marker, and introduce routine equity checks in quarterly reviews. (High priority, OSC Managers, DPMO/M&E units)
• Plan any scale-up around the existing centres as hubs of excellence, paired with a decentralised first-response network in clinics and police posts. (Medium priority, DPMO, line ministries, regional leadership)

LOOKING AHEAD

The OSC model has proven its value at first contact: survivors who reach Mbabane or RFM hospital receive faster, more coordinated, more dignified care than fragmented services would otherwise provide. Sustaining and scaling this success now depends on predictable financing, finalised standard operating procedures, reliable after-hours systems, and the data needed to track survivors through to a justice outcome. With these foundations in place, Eswatini is well positioned to extend the OSC approach responsibly and sustainably to reach the survivors who cannot yet access it.