Blog | March 8, 2017 | Ciana-Marie Pegus

Today is International Women’s Day. In South Africa, women’s day is celebrated on 9 August, to commemorate the moment in 1956 when 20,000 women marched to protest against the imposition of the infamous apartheid ‘pass laws’ which limited their freedom of movement.

The spirit of this key turning point in women’s empowerment and political mobilisation was captured in a popular protest song: Wathint' Abafazi Wathint' imbokodo! – now you have touched women, you have struck a rock.

Interwoven with the evolution of South African women’s resistance is long history of violence against women. According to a report released today by the Foundation for Professional Development (FPD), South Africa continues to have high rates of rape, with few prosecutions and fewer convictions.

Khayelitsha June 24 2011, members of Treatment Action Campaign, stage a protest outside Khayelitsha Magistrates Court. Photo © Eric Miller

Members of Treatment Action Campaign stage a protest outside Khayelitsha Magistrates Court. Photo © Eric Miller

What is being done to tackle rape and gender-based violence (GBV)? Over the past decade the government has established Rape Crisis Centres (RCCs), and more recently Thuthuzela Care Centres (TCCs) which employ specialists to attend to the medico-legal and psycho-social needs of people who have been raped.

Making All Voices Count provided an innovation grant with embedded practitioner research to FPD to develop a client experience app to enable clients of RCCs / TCCs to provide confidential feedback about these services. By giving the rape survivors a platform to voice their individual client experience, the app was designed as a tool to strengthen governance and accountability of post-rape service providers, and drive improvement in overall quality of care.

Researching the experiences of post-rape service users and piloting the app

The FPD team, led by Suzanne Johnson (Head of Technical Assistance) and Nomsa Mahlalela (Senior Researcher), worked with follow-up clients accessing services at four RCCs / TCCs in the Tshwane district. The app enabled participants to rate different aspects of the care they received at the centres, at police stations and at courts - or all three.

Before embarking on the pilot, FPD researched the technologies clients already had or were familiar with. In the inception phase, they unpacked the drivers of client satisfaction from the perspective of staff at the Department of Health and at the centres.

They then invited individuals who had received post-rape care to participate in three focus group discussions, in which participants were invited to discuss their priorities post-rape services, and to share their honest opinions.

Clients spoke of judging and blaming treatment by police officers; long delays, waits and general discomfort; failures to disclose the side effects of post-exposure prophylaxis by health-care workers; a lack of follow-up by prosecutorial staff and police investigators; and inadequate psycho-social support.  But experiences were not all negative. Many clients expressed deep gratitude for and satisfaction with the professional, courteous, caring staff that work at TCCs / RCCs.

Once developed, the app was then piloted for three months at the four centres, where 22% of all new walk-in clients chose to use it. The centres received a high average rating of 4.63 out of 5.

Unpacking complaints, feedback, rights and entitlements

These high ratings are not easily reconciled with lapses in care that were flagged during the focus group discussions. So what were clients actually rating?

Public health literature indicates that people don’t tend to complain. They think that complaining isn’t effective, or that they need the service, or that they don’t have a right to complain because it’s free. - Suzanne Johnson, FPD Head of Technical Assistance

Client reluctance to complain is only part of the story. Clients struggled to distinguish the quality of services received from the individuals giving them those services. Johnson notes “I think what people are rating in the different dimensions on the app is human engagement, the quality of interpersonal interactions.” And as staff at the centres have been properly trained and sensitised to deal with victims of rape, they fared well on the client experience app.

Victims don’t know which services should be provided and what the proper standards of care are. They don’t know what to expect, so they are ok with whatever services they receive. - Nomsa Mahlalela, FPD Senior Researcher

Clients need to know their rights and entitlements in order to deliver informed feedback. And encouraging a culture of providing confidential feedback is essential.

If clients get into the habit of providing feedback and expressing their voices, and become accustomed to centre staff listening to them and acting on the basis of that feedback, then they’ll start demanding better quality services. - Nomsa Mahlalela, FPD Senior Researcher

From feedback to service improvements – and then?

In the pilot, centre staff were very receptive and responsive to client feedback. Mahlalela facilitated weekly sessions with staff to help them analyse data from the client experience app and identify areas for improvement at the district level. There was a causal relationship between these discussions, improvements in the quality of service, and increased client satisfaction. Staff at the centres were encouraged to see the client experience app as a mechanism for them to understand and assess their own performance, and through participating in the research and the pilot they came to further value their role and work.

Following the pilot, the app is now being rolled out at Thuthuzela Care Centres by the Increasing Services for Survivors of Sexual Assault in South Africa network with the support of the National Prosecution Authority. But while this could be considered a successful example of scaling up, its longevity and sustainability is unclear.

The MAVC grants for this work have finished. On-site champions haven’t been hired in new districts, and FPD has limited resources to accompany centre staff in different districts to analyse client feedback.

Johnson laments that while the Department of Health knows that it should prioritise GBV response and strengthening TCCs / RCCs, “donor funding in South Africa results in a focus on HIV / AIDS and TB response”. Challenge funds like MAVC do support innovations in governance that wouldn’t be able to get funding elsewhere. But these innovations are – and are likely to always be - reliant on public funds and resources. So the continued success and scaling up of the client experience app is constrained by a risk-averse funding and policy environment, which forces institutions to home in on donor priorities.

And in South Africa, this is compounded by the lack of institutional home for and championing of work on GBV. There isn’t a national strategic plan to deal with GBV, despite years of campaigning by activists, health-care workers and civil society organisations.

FPD’s research reports clearly demonstrate why tackling GBV and better delivery of post-rape services must be priorities for the Department of Health, the National Prosecution Authority and the South African Police Service. If the client experience app were coupled with basic information on standards for post-rape services, and could continue to be pushed by champions within TCCs / RCCs, it could go a long way towards fulfilling these aims.

About the author

Ciana-Marie Pegus is IDS Research Officer for Making All Voices Count

About this blog

This blog was cross-posted by the Institute of Development Studies