Gender-based violence

Thuthuzela Care Centres


Thuthuzela Care Centres

UNICEF/South Africa/2008/Pirozzi
© UNICEF/South Africa/2008/Pirozzi
“Thuthuzela”, a Xhosa word meaning comfort, represents a radical approach to rape care management that is producing excellent results for South Africa in the communities across the country that are lucky enough to have one of them.

Helping victims of sexual violence become survivors

South Africa’s much admired Thuthuzela Care Centres, well known as models of good practice in the fight against rape linked to HIV and AIDS by countries in Africa and as far away as South Asia and Latin America, are this country’s unique one-stop, integrated response to the burgeoning incidence of violent sexual acts against women and children and its intersect with HIV and AIDS.

“Thuthuzela”, a Xhosa word meaning comfort, represents a radical approach to rape care management that is producing excellent results for South Africa in the communities across the country that are lucky enough to have one of them. “They are a critical part of South Africa’s anti-rape strategy, aiming to reduce secondary trauma for the victim, improve perpetrator conviction rates and reduce the lead time for finalising cases,” says Advocate Thoko Majokweni, Director of the Sexual Offences and Community Affairs Unit at the National Prosecuting Authority.  

So important are the Thuthuzelas to the country’s fight against HIV and AIDS that the Government of South Africa, in a move to strengthen implementation of its Domestic Violence Act and Sexual Offences Bill, continues to establish more centres. 

The Thuthuzelas in operation in public hospitals in communities where the incidence of rape is particularly high, are also linked to the sexual offences courts, a new and unique South African anti-rape intervention. As part of the strategy, a specialised Sexual Offences Court is staffed by a committed cadre of prosecutors, social workers, investigating officers, magistrates, health professionals and police, and located in close proximity to the Thuthuzela.

Restoring Dignity and ensuring justice for victims of sexual violence

Thuthuzela’s integrated approach to rape care is one of respect, comfort, restoring dignity and ensuring justice for children and women who are victims of sexual violence.  The rape victim is first removed from the crowds at the police station to a more victim-friendly environment before being transported by ambulance to the Thuthuzela one stop care centre at the hospital. 

Enroute, she receives comfort and crisis counselling from a trained ambulance volunteer and once at the centre, she is ushered to a quiet, private space, welcomed by the site-coordinator and a doctor immediately summoned to conduct a medical examination.  Information on the procedures to be performed is then provided and the patient signs a consent form for medical examination and blood specimens. 

If the medical examination happens within 24 hours of the rape, she is offered the opportunity to take a bath or shower and to change into soft, clean clothes to help cushion bruised feelings from the incident.  After that, the investigating officer on call to the centre, takes the victim’s statement. 

Thereafter, she receives appropriate medication and is given a follow-up date for further medical treatment, before being transported home. “This process ensures that service providers are available to a rape survivor in one location, rather than her being shuttled around throughout the criminal justice system”.

Caring for the youngest victims of rape

Doctors at Thuthuzela centres have reported seeing increased numbers of child victims.  Sadly, some of them are as young as three months.  Accordingly, the need for specially trained child-friendly nurses or care-givers to receive and comfort children before they are taken for examination is critical.  As such, UNICEF is stepping up efforts with its partners to make the centres child–friendly, offering technical expertise for the installation and availability of special tools like two way-mirrors, posters, drawings, and anatomically correct dolls comprising five family members, to help prepare children to appear in court, should that become necessary.

At the same time, UNICEF is working to strengthen the centres’ offerings in other service areas. “The idea is to ensure a child-friendly environment right from the start - from the crime reporting stage all the way through to the provision of follow-up victim support services,” UNICEF says.  The children’s organisation has supported research*  showing that training and development of a specialised, multi-disciplinary team to serve at Thuthuzela centres is essential. “Without the skills to conduct a proper investigation, ask the right questions, fill in the appropriate forms, for example, the critical J-88 the form that links medical and legal requirements for the victim, extensive delays in can result.  

To ensure that the Thuthuzela integrated strategy for prevention, reaction and support for rape victims works, responsibility falls within the Sexual Offences and Community Affairs Unit established in 1999 at the National Prosecuting Authority.  The centres are managed by a top level inter-departmental team comprising Justice, Health, Education, Treasury, Correctional Services, Safety and Security, Local Government and Home Affairs, Social Development and designated civil society organizations.  Since then, the Unit has been working to develop best practices and policies reducing victimisation of women and children, while improving prosecution, particularly in the areas of sexual offences, maintenance, child justice and domestic violence.

Thuthuzela impact

The Thuthuzela model has already improved the process of reporting and prosecuting rape and other sexual offences, and educing secondary trauma to survivors as the entire process takes place in a dignified and friendly environment.  According to Advocate Majokweni, “At the heart of the success of the Thuthuzela approach is the professional medical and legal interface and a high degree of cooperation between victim and service providers from reporting through investigation and prosecution of the crime, leading up to conviction of the offender.”  

And offender conviction rates are up too. “Higher levels of awareness have resulted in an increased numbers of cases reported at police stations and taken immediately to the Thuthuzelas.  In addition, there has been a dramatic drop in the time spent to investigate, prosecute and convict perpetrators – formerly from approximately 3-5 years, to less than 6 months today,” she says. 

In South Africa, child sexual abuse is exacerbated by widespread poverty, migration, social and economic insecurity, and inadequate childcare arrangements.  The high prevalence of HIV and AIDS in communities is generally linked to very high risk of infection exacerbated by violence.  An unexpected HIV-positive test diagnosis may lead to violence against one’s spouse or children, or alternatively, non-disclosure.  Another cause often cited is economic dependency which further increases risk because of disempowerment which extends to sexual choice-making. In the South African conntext, gender-based violence is not limited to men as ‘perpetrators’ and women as ‘victims’, nor is it exclusive to heterosexual relationships.

*  An Investigation  into the Causes of the Low Investigation and Arrest Rates of  Sexual Offences Channelled through the Thuthuzela  Care Centre, Gender, Law and Development Project, Institute of Criminology ) Faculty of Law) UCT.  Artz, L., Smythe, D., & Leggett.T. (2003)

Services offered at the Thuthuzela Care Centres

  • Comfort from a site co-ordinator or nurse.
  • An explanation of how the medical examination will be conducted and what clothing might be taken for evidence.
  • A consent form to sign, that allows the doctor to conduct the medical examination.
  • A nurse in the examination room.
  • After the medical examination, have a bath or shower at the centre.
  • An investigation officer will interview the survivor and take his/her statement.
  • A social worker or nurse will offer counselling.
  • A nurse arranges for follow-up visits, treatment and medication for Sexually Transmitted Infections (STIs), HIV and AIDS.
  • A referral letter or appointment will be made for long-term counselling.
  • The survivor is offered transportation home by an ambulance or the investigating officer.
  • Arrangements for the survivor to go to a place of safety, if necessary.
  • Consultations with a specialist prosecutor before the case goes to court.
  • An explanation of the outcome of the trail process.

List of Thuthuzela Care Centres

A tribute to Thuthuzela Care Centres
by June Madingwane





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Footballer and UNICEF Goodwill Ambassador, Quiton Fortune's visits the Baragwanath Thuthuzela Care Centre

Read Quinton's impressions of the Thuthuzela centre taken from his daily Soweto diary, South Africa 16 June 2005, Youth Day.


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