Quality of services for rape survivors in Kenya Sexual violence is a serious health and violation of human rights issue in Kenya. Sexual violence has adverse psycho-social and physical consequences on the survivors. Following the violence that erupted after the disputed general elections in 2008, the wave of sexual violence targeting women and girls were the clearest manifestations of the intensity of sexual violence in Kenya. Rape violence threatens the attainment of goals of global development and other national goals as contained in Vision 2030 as it leads to affecting the survivors and their health. Sexual violence is a significant risk factor that contributes towards the vulnerability of contracting HIV/AIDS. Sexual violence is an issue of concern in the transmission of the AIDS virus especially among adolescents. These require measures comprehensive to address the issues of sexual violence and meet the complex and diverse needs of the survivors (Bott, Guedes,Guezmes & Claramunt, 2004). Care for the survivors of the violence starts from medical treatment that begins with the management of physical injuries, emergency medication that will ensure the reduction of the risk of contracting viruses. The care also entails the provision of emergency medication that will shield the survivor from getting pregnant. Psycho-social services offered which include counseling to enable the victims deal with the shock and legal procedures for the victims to access justice. Services of sexual violence are increasingly being scaled up as part of standard care in Kenya (Campbell & Raja, 1999).The package of care includes documentation, physical examination, prophylactic treatment for sexually transmitted diseases, pregnancy, and HIV tests, services of counseling and the preparation for the system of justice. The qualities of services that are offered vary with no methodologies for continuous improvement and monitoring. Studies reveal an improvement of services provided to the survivors of violence. Institutionalization and development of a framework that gives a structure for support and monitor adherence to the standards are set, and the necessary interventions are paramount. Some guidelines have been formulated to provide general information about the management of sexual violence in Kenya and focus on the necessity to give services that tackle all the needs of the victims. The services include legal, humanitarian, medical and psycho-social. The available services recognize that children form a high percentage of victims of sexual violence and give provisions for them that address their delicate aspects separate from those of adults. Guidelines for the above facilities are available health centers whereby the ministry of health ensures that their implementation addresses all the needs of survivors of sexual violence in the country.
Analysis of the current state In spite of many measures that exist to address rape violence in Kenya, communities in the country are yet to stamp out or reduce such cases. The victims of the vice in Kenya, like in most of other nations in the world are women. The cases range from sexual violence, physical abuse to other violations that include deprivation and physical abuse. The main reasons for failure to reduce the vice in the country include the inaccessibility of laws that criminalize and the complicated procedures that the victims have to undergo to access justice. Sexual violence is a serious issue as per the human rights movements in Kenya. The health sector in the country bears majority of the economic burden of the violence through indirect expenditures and public financing. The Kenya Sexual Offenders Act No 3 of 2006 defines a sexual crime as the crime that is stipulated in the act (Digolo, Karuga, Nduta & Kilonzo, 2010) Sexual violence includes acts such as rape, defilement, attempted rape, gang rape, attempted defilement, sexual assault, incest to both men and women among others. Sexual violence has profound impacts ion mental and physical health of the survivors. The violence causes physical injury, increased risk of reproductive and sexual health problems and has immediate and long term effects. In the year 2012, a total of 611 survivors were seen. The Gender-Based Violence Recovery Centre (GBVRC) attended for a total of 3,275 survivors of the violence between May to December of the same year. Cases attended to range from rape, defilement, sodomy, physical assault, indecent acts, multiple assaults and sexual assaults. On average, the female gender forms 80 percent of the survivors of rape violence majority of whom are under eighteen years. Police statistics reported 2,800 cases of rape 2004 which was an increase of 500 cases that were reported in the previous year. Amnesty International presented a report in 2002 that indicated that rape victims in Kenya had an enormous problem in persuading the prosecuting authorities and police that they had been raped. The victims undergo great tasks as they seek to prove that they did not agree to the act or that the perpetrator did force her. The GBVRC, which is the only such center in East Africa, attends to up to 15 domestic violence and rape survivors every day. Since its establishment a few years ago, the center has attended to 4,500 such cases. Statistics reveals that 25% of 12-24-year-olds lost their virginity by force. Nairobi, Women's Hospital, receives 18 cases of incest and rape every day. Of the 49% reporting to have been raped in their lifetime, one in four had undergone the violence in the previous 12 months. In an estimate, abuse cases in Kenya increased by 5,200% in 2008 compared to 2007. Kenya Police statistics reports that the incidence of rape reduced from 1,291 in 2006 to 876 in 2007 only to rise in 2008. The police attribute the rise to post election violence that took place in the country.
Recommendations for improving the quality of services To curb some of the challenges that arise from rape, empowerment of women as a vulnerable social category must be given priority and prominence. According to statistics, women are the most affected by rape cases. The law must be more active in protecting the rights of women through imperative reforms. From the data collected, there is a need for deeper and greater delving by FIDA and other like-minded organizations in culture and related matters that underpin rape cases among Kenyan communities. This will be aimed to fathom into the causes of the practice. In the present times, many of the activities of such organizations are directed to legal aid, which simplifies that they aim to treat the symptoms and not the causes of rape. The organizations that address rape should seek to make a difference by coming up with negotiating and dialog approaches rather than the current coercive ones (FIDA, 2001). Such organizations are best placed to play the coordination and leadership role and embrace the said methods and approaches. Organizations that address such matters should frame new interventions to help victims of rape recover from the trauma. The bodies should reposition their programs and come up with the best and most suitable approaches that will enable victims deal with the rape cases. The government should ensure that police do not request bribes from the victims in order to receive justice since this will scare them off, and they will not report such cases. The Kenyan government alongside other NGOs with the interest of helping the victims of rape should teach people, particularly women on defense tactics that they can apply in the case of attack. Such methods include wearing of tight clothing and avoid loose and explosive clothing that attracts rapists (GBVRC, 2014).
Steps to be taken to minimize the secondary victimization of victims Secondary victimization is the re-traumatization of sexual and abuse of the rape victims. It is an indirect method of assault that occurs through the remarks and responses made by people and institutions to the victims. Secondary victimization includes blaming the victims, inappropriate languages and behaviors by the medical personnel and other organizations that have access to the victim post-assault case. It is clear that the majority of the victims of sexual assault will never report the crime to the police. The reluctance comes as evidence indicates that response and climate systems can be and in most cases are hostile towards victims. With no reports, it is not possible to hold to account the perpetrators who make the factors that lead the victims’ not reporting essential in this study. Creating a safe environment for reporting is a significant factor as the victims will free to do so which will enable them attain justice and the necessary help (IRIN, 2015). Police should be educated about the importance of taking imperative actions when the cases are reported. They should be trained to understand issues regarding rape that will improve the services and reduce secondary victimization. Authorities who the victims report to should ensure that the people in command avoid asking questions that imply victims are to blame for the assault. Individuals who interact with victims are should avoid explicit statements that suggest the actions of the victims contributed to their assault. Authorities should ensure that victims do not share their stories with more people than is imperative to a fair process. The needs of the victims should balance with the necessity of gathering enough evidence to move forward with a particular case. Procedures should be utilized to minimize the stress that comes up in the course of interviews. Cross-examination of question that does not relate to the case that the victim is reporting should be kept to a minimum. Victims that come forward should receive protection and should not be harassed by the necessary authorities and confidentiality processes for the sexual assault cases should be practiced. Victims should be involved in the decision-making process that regards their cases; they should be treated with dignity and respect in the entirety of the process (Kinyanjui, 2008). Authorities should be educated on the reporting strategies and procedures, the rights of the victims and the necessary resources. By understanding and addressing the principle factors that lead to underreporting and the reporting itself, perpetrators should be brought to book for the crimes that they commit. Secondary victimization can negatively influence the self-esteem of the victim, their faith in the future and trust in the legal system. Potential causes of these effects include the outcome of criminal proceedings as well as the methodology.
Effects of the political economy of health Universal coverage of health depends on having the imperative human resources to deliver health care services. Kenya falls into the category of the African countries that experience shortages in the area of human resources personnel. The primary causes of the crisis include inequitable and inadequate distribution of the health workers, weak development, and high staff turnover. The shortage affects most of the workers available. An overall shortage of nurses in the public sector in the country is complicated by the varying characteristics of the workforce and mal-distribution across counties. Stakeholders should seek to support improvements in human resources information that are available. The above will help address issues that relate to deficiency of the healthcare workforce and help address shortages of equitability of patients and rape victims are to receive standardized care (Digolo, Karuga, Nduta & Kilonzo, 2010). Focus on women’s excess disease burden is justified to fill spaces in knowledge regarding the health care of women that form the weaker sex in the male dominated society in the past, medical research assumed that women were more vulnerable biologically which is clearly the male bias. Politicians in Kenya politicize the issues regarding distribution of nurses in the country. Some places in the remote Kenya have inadequate personnel in the health care sector which leads to victims of rape not receiving proper care. Some of the reasons that relate to deficiency of healthcare staff in the country include the unwillingness of the International Monetary Fund (IMF) and the World Bank to submit the money that is required to hire sufficient healthcare providers. Compared to the last ten years in Kenya, people live for ten years less on average, more and more children die while very young and greater populations of the kids that survive face stunting. IMF is held responsible for this as the institution ahs an obsession with low rates of inflation that is one of the foundations for the liberalization of trade that leads to hurting people and starve the economy. Specific policies of IMF, in particular, the low ceilings it stipulates for the rates of inflation and wage expenditures in borrowing countries are illogical and detrimental. The IMF mounts for the maintenance of such restrictions with countries like Kenya stating that the body should restrictions that it has imposed on borrowing state. The logic of demanding continuity decreases in public wage bills as per the IMF routine targets of inflation (Kinyanjui, 2008). Kenya’s healthcare system was hit hard by the policies of structural adjustments that the IMF and the World Bank imposed on conditions on loans and prerequisites for getting the approval of IFI support of the economic policies of the country. The plans were formulated in 1980 and have left a mark on the healthy sector in Kenya. The policies aim at cutting expenditure budgets and, as a result, dispensaries and local health clinics had fewer supplies of medicine and user fees became a familiar figure. Their was deterioration of the standard care in public hospitals which increased pressure on the largest healthcare facility in the country Kenyatta National Hospital in Nairobi. The Kenyan government and the IFI regularly indicate that public health spending will escalate. With the many promises of increased resources for the health care sectors and the World Bank acknowledging the shortage of healthcare staff in the country, people expect that the government will hire more nurses. The IMF openly prioritizes inflation that targets over almost all the factors in countries where it works. When pressed with the question over health spending as they have in the past indicated, officials respond that inflation is considered a tax that hits the poor the hardest. The reason the IMF, with its power to exclude a nation from the global economy by declaring it off-track insisting on the reduction of government payroll in not clear. Addition of employees to the payroll of the government especially if done with borrowed funds is considered by economists similar to those in at the IMF to increase inflationary pressures on developing countries (Ambrose, 2006).
Analysis of 4 major areas affecting the quality of services
Cultural factors

Men dominate the society in Kenya. It becomes difficult for women survivors of rape to access the services that they are supposed to receive after the incident. Wherever a victim of rape walks into the hospital and finds a male to attend to her, men tend to ridicule the victims, and some go as far as calling them names claiming that they were not raped. In such cases, the victims of rape may leave the hospital and never come back again. It is dangerous when the survivor is infected by diseases that include HIV/AIDS and other deadly viruses.
Institutional level factors Institutional level factors that affect the quality of services for rape victims hinder the process of justice. In police stations, victims are subjected to unnecessary questions that do not relate to the case. Police at times go to the extent of claiming that the victims of rape agreed to the act. They may even ask for bribes before they make a follow-up for the case. In such a situation, victims are de-motivated to report such cases that hinder the process of justice. In hospitals and such other places that victims go to seek help after they have been raped, doctors and the rest of the personnel available at the place frequently do not believe them (GBVRC, 2014). They subject them to questions and ridicule. Some claim that the victims consented to rape. The costs that come with the treatment of rape cases at times are expensive, and many of the victims cannot afford the fees. If the victim was infected with a disease in the course of rape, the virus may as they seek money for treatment.
Interpersonal services (service concerns, client issues) Services offered to rape victims may be hindered by concerns of the client and other service issues. Issues of the customer include an instance whereby the victim requires certain tests to be performed on them, but the medical personnel deny citing lack of money. The services that are offered to the victims vary in different places. Some healthcare institutions require experts that are qualified in the field of providing care for the victims. Counseling sessions are imperative to the victims as they seek to regain their self-esteem and rebuild their lives after the horrifying experience that they undergo in the period of rape. Statistics indicates that victims of rape end up committing suicide if they are not counseled properly which makes the counseling sessions essential (FIDA, 2001). Some hospitals lack the necessary materials to treat the survivors of rape, and the challenge is common in many hospitals in Kenya particularly those in the remote areas.
Individual level factors Working with survivors of violence is a challenging task for providers of health care in a number of ways. It requires that suppliers of healthcare make use of a broad range of clinical skills for which they may not have gotten in the course of their medical training. Listening and supporting the survivors of rape requires providers of health care to step out of their pride and give the necessary assistance (Orth, 2002). It becomes a hard task when suppliers of health care have are exposed to such violence. It implies that health care providers listen to the same stories time and again which may over time result in accumulated stress levels in the supplier and ultimately burnout and trauma. Vicarious trauma describes a situation whereby the healthcare provider experiences trauma symptoms to the victim after listening to the escapade. Professionals who experience such reveal it with nightmares, deep thoughts, and hyper-vigilance even though they have not personally undergone the experience. The condition leads to burnouts or emotional exhaustion from interacting with survivors. The physical warning signs of burnout include fatigue, headaches, and irritability. It is as a due to this that healthcare providers are required to develop strategies that will aim at the reduction of stress, continued education and preventive vacations. Examples of individual level factors include alcohol abuse, intergenerational sex, and substance abuse (Wakaba, 2014).

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