Association between blood manganese and cognitive function in a national representative survey.

Sexual violence impacts about one-third of women globally, with a multitude of negative consequences to health and well-being, including morbidity and mortality from injuries, sexually transmitted infections (STIs), unwanted pregnancy, and psychological trauma, among other effects. Best-practice standards in care and treatment for sexual violence have underscored the importance of a multisectoral approach that provides coordinated, timely, and comprehensive services that are responsive to the needs of survivors, including medical care, lifesaving treatments, and effectively linking survivors with non-clinical resources. At its best, the health care system can serve as a safe space and critical entry point to care and justice for survivors of sexual violence. Evidence indicates health care providers are well-placed to act as first responders to proactively identify survivors and deliver and coordinate integrated medical care, and often are also best positioned to connect survivors to a constellation of non-medical services such as psychosocial support and legal aid. Enabling health care providers to be effective in a frontline care coordination role requires the structural support of health care systems, including definition of a basic package of essential sexual violence services provided by health facilities; articulation of pragmatic approaches to violence screening and active case identification; and ongoing training and supervision supported by clinical protocols. The health care system should also ensure continuous availability of essential clinical supplies, commodities, equipment, and infrastructure; straightforward referral pathways; and documentation and routinized monitoring and evaluation for adaptive management, quality improvement, and evidence-based decision making at national and sub-national levels. Despite the key role the health care system can and should play in supporting survivors of sexual violence, many health facilities in low- and middle-income country (LMIC) settings remain under-resourced to deliver effective care. While integrated service delivery models and specialized sexual and gender-based violence (SGBV) in-service trainings have been implemented within health facility settings in a number of LMIC settings, case studies from various countries have identified common barriers to effective SGBV care responses. These include high clinical staff turnover; inefficient and inadequate cascading of training to frontline health care providers; and insufficient infrastructure to ensure survivors’ privacy within health care settings. Deeper understanding of care pathways and the current quality and availability of sexual violence services within LMIC health care systems are critical for identifying gaps and developing effective health systems-focused interventions that integrate global best practice and context-specific capacity.