39 involving a three-year panel/cohort study among more than 4500 young respondents and at least three rounds of data collection--in 2003, 2004, and 2005(Solorzano, Peña et al. 2004). This study will measure the program’s success in changing attitudes and behavior around gender, stigma, HIV/AIDS and GBV.

# **2.3.6  Policy recommendations**

It is clear that the health sector can play a key role in the identification and support of survivors of violence. Based on existing evidence, the following approaches are recommended for strengthening the capacity of health providers to address GBV: _Integrate violence issues horizontally into health care services, especialy sexual and reproductive health services._ The accumulated experience in the region has shown that GBV cannot be addressed as a vertical stand-alone program. Vertical programs are likely to reach only a fraction of women who are in need of support. In contrast, horizontal integration of violence into primary care services permits the expansion of basic support for abused women and children throughout the health sector; moreover, because of the serious impact of violence on women’s sexual and reproductive health, it is particularly important that providers of services for pre-natal care, family planning, sexually transmitted infections and other reproductive health services routinely ask women about violence and be prepared to address the specific needs of abused women. The ongoing processes of health sector reform throughout the region provide an excellent opportunity for integration of services for GBV into health services more generally.

_Use a systems approach for institutional change._ Numerous studies have demonstrated that training of health providers to address GBV has no appreciable effect on provider behavior unless it is accompanied by changes in procedures and systems. Even in institutions where successful screening programs have been implemented, gains are quickly lost in the absence of continuous followup and supervision. Institutional change must include implementation of new procedures with regard to patient flow, documentation, measures to ensure privacy and confidentiality, and the creation of referral networks. Although norms and protocols cannot change providers’ behavior unless they are given the tools and skills to implement them, the creation of national policies and norms provides a critical enabling environment for initiating change. Providing emotional and technical support for staff dealing with violence victimes is also essential for maintaining the quality of care and the emotional health of providers.

_Address provider attitudes_ **.** As mentioned above, health providers often share the same stigmatizing attidudes as the population at large, and these can be a serious barrier towards improving the quality of care for victims of abuse. Therefore, provider training must deal with gender and power relations and allow providers an opportunity to challenge their own beliefs and prejudices.

_Encourage coordination with other sectors._ Currently, as noted above, there is a generalized lack of coordination between the health sector and other key sectors such as the justice and social welfare sectors; moreover, contradictory policies and procedures between different