In Trinidad and Tobago, one in three women in intimate partnerships report having experienced intimate partner violence. Evidence indicates that women and girls are most vulnerable during crisis or emergency conditions such as the COVID-19 pandemic. There was a 140% increase in cases of abuse of women and girls reported to the Trinidad and Tobago Police Service (TTPS) in 2020, compared with the same period the previous year.
According to the Trinidad and Tobago National Women's Health Survey, after family and friends, health care workers are the people that women survivors most often tell about the violence they have experienced. Health care providers are well positioned to provide critical support through the delivery of high quality physical and psychological care and advice to help women develop strategies to enhance their safety. Therefore, the health system plays a critical role in prevention, as well as care.
In recognition of this role, the Pan American Health Organization (PAHO) leads implementation of Pillar 4 (Strengthened service delivery to survivors) and Pillar 5 (Quality and accessible data to inform policy making) of the Spotlight Initiative, in the health sector. The Spotlight Initiative is a global, multi-year partnership supported by governments, the European Union, the United Nations and civil society organizations. Its overall goal is to use prevention strategies and strengthened multi-sectoral responses to eliminate all forms of violence against women and girls by 2030, particularly those most marginalized.
One of the key deliverables under Pillar 4 is development of competencies to identify violence in the clinical context and to provide first-line support to survivors. Accordingly, a major training initiative of health-care providers was planned and implemented during the period 14 – 30 July 2021, with the support of Dr. Roshan Parasram, Chief Medical Officer, Ministry of Health, Trinidad and Tobago. The training curriculum was based on the WHO curriculum for training health-care providers in caring for women subjected to violence and on the Trinidad and Tobago National Clinical and Policy Guidelines on Intimate Partner Violence and Sexual Violence.
The participants comprised at least one nurse, doctor, social worker and a person from the training unit from each of the five Regional Health Authorities (RHAs). There were also two representatives from the University of the West Indies (UWI) School of Nursing. Ms. Britta Baer, Violence and Injury Prevention Specialist from PAHO Washington DC, and Dr. Caroline Allen, Spotlight Initiative Project Manager, led the training course.
Ms. Britta Baer stressed the significance of this milestone activity. "It's so important to build capacity around health services to respond to violence, more important now than ever before. So it's very timely that Trinidad and Tobago is taking the lead on this. We have so much evidence that shows what a difference it makes to survivors, the family, the communities, the economy."
After the training, the expectation is that each of the five RHA teams of trainers will target and train 50 persons in their respective RHA, by 1 October, 2021. UWI's School of Nursing also plans to conduct training. PAHO will continue to provide technical support to achieve a successful roll out, including communications to promote the training throughout the health sector.
Participants recognized the importance of quality, first-line support to a woman who has suffered sexual abuse or violence from a partner. They also learned that even in situations where survivors do not acknowledge that they have been subjected to violence, health-care providers could still help by providing information on services available and ways to enhance safety. All participants agreed that the training would help them deliver improved services to survivors.
Commenting on the initiative, Dr. Erica Wheeler, PAHO/ WHO Representative, Trinidad and Tobago, remarked that the Spotlight Initiative represented an opportunity to build sustainable changes in health care by training trainers and supporting them in building capacity throughout the health system. "…… this training program, and the idea behind it is not just to do training and forget about it, but we want to make it sustainable. My desire, my dream is that it gets embedded in the work of the Ministry of Health."