Title: Mapping the health systems response to violence against women:  Key learnings from
five LMIC settings (2015-2020)
Version: 1 Date: 25 Mar 2021
Reviewer's report:
This paper has the potential to be a valuable resource for those working for health system reform
for VAW. However, the rationale and outline for your design, methods requires considerable
expansion, and the results and discussion much better explained and restructured, before it is
suitable for publication in this reviewer's opinion.
I will address my comments to the major points but there are a few small edits that require
attention too.
Your introduction is fluid and clear, well written.
1. Are you are using the WHO Health system response or the broader Handbook of system
indicators as your FW? It would help other readers not as familiar to better clarify in your intro,
that if it is the VAW HS FW, that it comprises (1) Leadership and governance (2) financing (3)
health infrastructure etc...rather than the few selected on p.3 ll 68-70. and what these mean.
2. You mention comparative analysis (should be in methods), but there are several steps that
appear to have been overlooked. Your methods section is very inadequate and I believe needs
to be much more transparent.
2 (a) Please provide better rationale for why this combination of scholars and several CARE
practitioners were chosen and why you did not access or cite the many other critical peer -
reviewed literature on the system roll-outs in these countries. For example,
* Colombini M, Dockerty C, Mayhew S. Barriers and Facilitators to Integrating Health service
responses to Intimate Partner violence in Low- and Middle-Income Countries: A Comparative
Health Systems and Service Analysis. Studies in Family Planning. 2017;March:1-22.
* Signorelli. MC, Taft A, Pereira PPG. Domestic violence against women, public policies
and community health workers in Brazilian primary health care (Violência doméstica contra
mulheres, políticas públicas e agentes comunitários de saúde na atenção primária brasileira). .
Cien Saude Colet 2018;23(1):93-102.
2 (b) As you have not done this, it is unclear how you conducted your analysis and then why
you came to the conclusions that you did.
2 (c) If you have had communications about their views with these scholars/practitioners, please
clarify how your questions were framed and related to the HS framework.
e.g. P.9 Under infrastructure ' please reference your challenges re all the problems in all 5
settings'
3. Please label Figure 1  and also explain in the text how strengths and gaps are identified?
Where should it be placed? Do you intend that it goes after the statement about the health system
response (ref. 5)?
4. P.7 There is no segue from your statement you have analysed according to this Framework
to health provider attitudes that would fall under 'workforce development' in the WHO model.
Further engagement with the Brazilian literature would also inform us that HCPs are 'mandated
to report any incident of violence to government and most are untrained.
5. Please reconsider your sub-headings as they do not relate to the framework. Perhaps explain
that at its core is 'women-centred care' and what that might mean. The section titled responding
to Survivors seems to cover workforce (training), coordination (for referrals), service delivery
(protocols). Please be clear how you are relating to this framework
6. P.8 You state that none of the settings provide legal sanction to either DV or SA. Please check
what you mean here as most have laws sanctioning DV. Brazil has the Maria Da Penha law
criminalising DV, Sri Lanka the Prevention of DV law etc.
7. Workforce training and development. A very important section. Can you perhaps add some
subtitles to these sections, perhaps those in the FW of training on communication and gender
sensitivity, worker support and mentoring,  and designated professionals - all of which you
do cover in Sri Lanka. I fully endorse you comment on the critical lack of evaluation of the
effectiveness of these programs.
8. Discussion P.14.
There are no results supporting your first statement about reluctance to respond nor is there any
reference to pre-service curriculum in your training sub-scetion. Please add both reference and
citation to the results section.
9. Please place the table 2 on prevalence and attitudes in the Results section. It should not be
brought up in discussion.
10 Similar with your truly shocking revelation that there are two finger tests for virginity
in protocols in Bangladesh. Again, this should be in the introduction or early section about
challenges to women-centred care. I strongly recommend you reread your discussion section
and remove any new data that should be included in your results.
11. Consider where your points on gender equality and social context should be. Could you
briefly discuss all the overarching social issues before you talk specifically about the health care
system.
12. Key summaries
You start with reference to a table (please say see below and number it) Again I respectfully
suggest that these tabular summaries are results and should be in that section. The summaries
are contained in the lessons learned.
13. Please be more critical about the study limitations.