GBV Response Capacity in Kisumu Level 4 Facilities

The eight recommendations in Section 12 sit alongside ARI's County SRHR Financing Brief^[1] and propose a set of changes that can be implemented within one budget cycle, at a county-wide cost in the order of KES 12–16 million per year.

Kisumu sits in a region with documented high prevalence of sexual and gender-based violence. KDHS 2022's domestic violence module places lifetime exposure to physical or sexual violence among women aged 15–49 in Nyanza region above the national average^[2]. The county has been a long-time recipient of donor-supported GBV programming, including PEPFAR DREAMS^[3] and a series of UN-led OSC interventions tracing back to the early 2000s^[4].

Despite that history, ARI's casework continues to surface predictable, structural failures at the moment of contact. The purpose of this assessment is not to argue that capacity is uniformly low, it is not, but to make the variation legible enough to be acted on at a budget line level.

The assessment rubric synthesises the Ministry of Health's National Guidelines on Management of Sexual Violence^[5] and PRC1 SOPs^[6], the WHO clinical guidelines^[7], the WHO management guidance for health systems^[8], and the UNFPA/WHO Essential Services Package^[9]. The rubric (Annex A) covers twelve indicators across six domains: identification, clinical care, forensic documentation, psychosocial care, referral, and data.

The scorecard below summarises performance against the 12-indicator rubric. Indicators and scoring are detailed in Annex A. Facility identifiers follow the Kenya Master Health Facility List^[10].

The cascade below traces what happens, in aggregate, to one hundred survivors of recent sexual violence who reach a Kisumu Level 4 facility within 72 hours of the incident. Numbers are ARI estimates synthesised from facility logs and KIIs.

The cliff-edge between psychosocial first aid (48) and day-14 PEP follow-up (33) is the single most consequential drop-off in the pathway. International evidence on PEP adherence shows that completion rates fall sharply where psychosocial support is not integrated into the visit^[11]. The clinical and psychosocial pathways are not parallel, they are causal.

The three composite case studies below are constructed from patterns observed during the assessment. Each is anonymised and the identifying details have been changed.

Stockouts of post-rape care kits are the single most cited obstacle in our casework, and the assessment confirmed the pattern at a county-wide level.

You order on time. You follow the procurement memo. The kit is not at the depot when you go. By the time it arrives, you are three weeks behind. You ration. You don't tell anybody. Until somebody you can't help walks in at midnight.

Mental health is the most consistently under-resourced dimension across the assessment. Only one of seven facilities had a dedicated mental health professional (psychiatric clinical officer or counsellor) integrated into the survivor pathway. The others rely on referral, when they refer at all^[12].

Child survivors of sexual violence have specific clinical, psychosocial and protection needs^[13]. The assessment found that none of the seven facilities had a fully child-friendly survivor pathway in operation. Three had elements (paediatric PEP regimens stocked, child-friendly examination rooms); the others relied on the standard adult pathway with ad-hoc adaptation.

Childline Kenya's 2024 statistics^[14] document continued high reporting of child sexual abuse in the wider region. The current configuration places the burden on individual clinicians who, at 22:00 on a weeknight, are asked to be paediatricians, counsellors, and child protection officers simultaneously. This is not a sustainable design.

The Office of the Auditor-General's 2023 performance audit on services to survivors of sexual violence flagged similar issues at national level^[15]. Comparative economic literature on the costs of unaddressed gender-based violence places the lifetime per-case economic cost at multiples of the per-case prevention cost^[16]. In Kisumu's terms, the indicative arithmetic is direct:

ART

Antiretroviral Therapy, long-term HIV treatment regimen.

CRH

County Referral Hospital.

DHIS2

District Health Information System 2, Kenya's routine health information platform.

EC

Emergency Contraception.

FTE

Full-time equivalent, staffing measure equivalent to one full-time post.

GBV

Gender-Based Violence.

JOOTRH

Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu.

KII

Key Informant Interview.

ODPP

Office of the Director of Public Prosecutions.

OSC

One-Stop Centre, integrated GBV survivor service location.

PEP

Post-Exposure Prophylaxis, antiretroviral medication started within 72 hours of HIV exposure.

PRC1

Post-Rape Care Form 1, Kenya's standardised survivor clinical and forensic form.

PRC kit

Standardised commodities pack supporting clinical and forensic care after sexual violence.

Psychosocial first aid

Immediate, supportive, non-clinical response to a survivor at the index visit.

SCH

Sub-County Hospital.