Why is a health program training police officers? In January last year, the Government of Rwanda published its first training manual for health providers in the care and treatment of sexual and gender-based violence (GBV) survivors. Organizations throughout Rwanda—including IntraHealth—were tasked with improving the performance of health workers. But the Ministry of Health decided it wanted programs like ours to do something unprecedented: train police officers, too.
When you think about it, it makes sense. Police officers tend to be a survivor’s first point of contact—not just in Rwanda but all over the world. Survivors often go to the police first instead of the health center. We realized that police needed to work in partnership with health providers, so rather than organizing separate trainings we decided to try training police and health workers—at the same time, in the same room, with the same training materials. Only by acting together can police and health providers offer the critical services a GBV survivor needs. The police provide legal protection and referral to health services, and health providers offer vital physical and emotional support and services, as well as documentation for legal prosecution.
On the first day of the five-day training, when police and providers walk in, we notice that the police are dressed in their uniforms and all sit together on one side of the room. Providers form their own group on the other side. The police seem to be thinking, “Why are we here?” Then we bring them together—urging them to sit together and mix—and explain why it’s important that they all attend the training. By the second day, it has all changed. Everyone sits together, and the police come in their civilian clothes. By the end, everyone is glad they are there, including the officers, who understand better how they can collaborate with health workers and health facilities. Health providers, too, understand how they can work with police more effectively.
Before the training, police say they have difficulty just knowing how to talk to a survivor. They know how to fill out the police report, and they know to refer a survivor for clinical care, but before the training, they don’t know how important it is to also provide psychosocial support to a survivor. The training makes them realize that, and then they want to know, how do I treat survivors, how do I behave with them, how do I talk to somebody who has just lived through such a trauma? And, although the training covers health care protocol that police won’t be conducting themselves, it’s important that they understand what services the health center offers so that the police can talk to a survivor about them.
Police officers also learn how important it is for a survivor to go to the health center quickly. For example, if the survivor has been raped, she is at risk for HIV and needs to get post-exposure prophylaxis; she is also provided with an emergency contraceptive method. Previously, survivors might go directly to the police and later to the health center, but this would delay treatment in the critical hours following an attack—because survivors would be at the police station making a statement and answering questions. After training, health providers and police agree the first point of contact for a survivor of violence should be the health center. That doesn’t mean that if a woman comes directly to the police, the police say “go away.” They accompany her to the health center directly. If a survivor goes to health center first, the police can come to the health center, making it easier for the survivor to talk to the police.
Health providers, on the other hand, learn how important it is to refer survivors to the police. Some survivors come to a health facility for services but never to the police—and before the training, providers often wouldn’t ask survivors to do so. Now providers realize GBV survivors don’t just need clinical care; they need to recover their own dignity and follow up with the perpetrator. Survivors need to seek justice. That is one of two very important points to this part of the training. The other is conducting risk evaluations—helping the survivor understand what might happen if she doesn’t press charges. According to the manual, it’s the provider who does this, but we make sure both police and providers know how to explain the importance of ‘getting the bad guy.’
The training also reinforces how critical it is for survivors to quickly get care—whether at the health center or police station. The Ministry of Health has declared that any kind of GBV—not just sexual violence—is a medical emergency and GBV treatment is a free service. At health centers, even receptionists are trained so that upon realizing someone has experienced any kind of violence, they place that person at the front of the line to get treated immediately. Many police stations have opened special offices for GBV cases so a survivor can go directly to this office and have her case dealt with right away. If the particular police station doesn’t have a special office, then as soon as the police realize it is a GBV case they are supposed to bump this person up the line to be seen quickly.
Through the HIV/AIDS Clinical Services Program, IntraHealth has made immense progress in forging collaboration between police and health workers—two groups critical to the well-being of GBV survivors. Now, police and health workers also work in partnership through community groups that raise awareness about GBV prevention and response.
During training, every time we see police officers mingling with health workers, we get the same feeling. We are seeing the formation of an important—and lifesaving—partnership.
Note: Between April and September 2010, the USAID-funded HCSP worked with district trainers to train 54 police officers and 294 health service providers using the new manual. HCSP covered all health facilities in the four HCSP-supported districts, including facilities supported by other partners.