The United Nations reports that more than one in three women have experienced physical or sexual violence at some point in their lives. Research shows that these traumatic experiences have both short- and long-term effects on a survivor’s health, making them more likely to seek help from a health care provider. This impact goes beyond physical injuries, often leading to psychological consequences as well. As a result, health care providers serve as a critical and oftentimes the first point of contact for survivors of sexual and gender-based violence. Proper care is essential to ensure their safety and improve outcomes.
Despite this, many health care professionals lack technical skills and confidence in screening and treating survivors of sexual violence. Additionally, negative attitudes toward survivors of sexual violence are common among medical staff. This not only affects the quality of care survivors receive but can also lead to further stigma and trauma and discourage them from seeking further treatment or reporting future violence. While there has been a focus on improving clinical skills, many health care professionals still lack training in forensic documentation and the important role they play in medicolegal investigations.
“The collaboration between the health care providers, law enforcement and legal systems will ultimately improve. This shared knowledge will foster trust and efficiency in resolving forensic cases benefiting both the victims of sexual and gender-based violence and Kenya’s justice system as a whole.”
The gap between the needs of survivors and the training of health professionals worldwide is no different here in Kenya, where women experience high rates of sexual and gender-based violence. According to the Kenya Demographic and Health Survey of 2022, 13 percent of women in Kenya have experienced sexual violence in their lives, while 34 percent have experienced physical violence. For years, PHR has worked across Kenya with civil society and survivor organizations to understand the scale of gender-based violence but to also examine the needs of survivors, including physical and psychological support, as well as legal avenues to access justice, redress and reparation.
As part of our work to build sustainability and co-develop solutions with impacted communities, our medical and human rights teams in Kenya have developed and piloted a rights-based curriculum on forensic documentation for health professionals. Now, thanks to a partnership with the Kenya Medical Training College (KMTC), new solutions are being scaled, set up for sustainability, and having a big impact.
Phase One: PHR and KMTC Identify the Gaps
The KMTC, a college under the Ministry of Health, is entrusted with the role of training various disciplines in the health sector, including clinical officers and nurses, who are often the first responders in sexual and gender-based violence cases. The college has 84 campuses strategically located in 45 of the 47 counties in Kenya, offering 95 medical courses within its 18 departments. PHR first partnered with KMTC in 2020, when PHR’s team conducted institutional capacity development projects at key health care facilities in Kenya. We co-developed a month-long clinical rotation training program to equip nearly 200 KMTC students with the skills to comprehensively assess and treat survivors of sexual violence and document forensic medical evidence to support their cases. The KMTC students learned first-hand how to conduct forensic evaluations and were mentored by hospital staff at the Gender-Based Violence Recovery Centers in these hospitals.
After formalizing the partnership in 2022, PHR supported KMTC’s clinical medicine department to assess the gaps in forensic documentation among health care workers. The results told us the needs were still stark: 61 percent of the respondents cited difficulties in handling sexual violence cases, including medicolegal documentation. Health workers indicated that the correct collection of evidence, as well as understanding laws around sexual and gender-based violence were also challenges.
Towards a Sustainable Solution
Guided by these new insights, PHR and KMTC collaborated on solutions. The first step was to formally integrate PHR’s curriculum into KMTC’s core diploma course, a three-year program offered through in-person classes across 42 campuses in the country with more than 2,000 students enrolling annually. In 2024, we additionally spearheaded a new degree track called the Higher National Diploma in Clinical Forensic Medicine. The higher diploma is a two-year program available for all enrolled nurses and clinical officers. Currently, it is being piloted at the Nairobi KMTC campus, with 25 students enrolled.
PHR and KMTC hope that this strategy for integrating forensic documentation into health professional curricula will standardize best practices in forensic documentation across the country, leading to improved patient outcomes both in terms of care and access to justice.
According to Mr. Felix Mutua, Head of Clinical Medicine Department, incorporating the PHR material and tools in both degree tracks makes clinical forensic medicine more practical for students and aligns it with the realities of modern forensic and clinical practice.
“The curriculum is valuable as it is helping students gain specialized knowledge and practical skills to handle medicolegal cases such as assault, sexual violence and workplace injuries,” said Mutua. “There is a lot of hands-on training in forensic case analysis, evidence collection and court testimony practical skills. The new and improved modules will help them gain a competitive edge by acquiring unique skills that are highly sought after in health care and legal professions. They will also be able to offer quality of care to our patients.”
Overall, PHR and KMTC hope that this strategy for integrating forensic documentation into health professional curricula will standardize best practices in forensic documentation across the country, leading to improved patient outcomes both in terms of care and access to justice.
What Next?
The next phase of the partnership will include training for lecturers at the college to equip them with the necessary tools and training to instruct students using this improved curriculum. This is especially vital due to the nuances of responding to sexual and gender-based violence. Partnerships with law enforcement, legal experts, and forensic specialists will be essential for training instructors.
PHR and KMTC also intend to continue collaborating with national health care institutions, professional bodies, and policy makers to ensure further adoption of the forensic documentation curriculum in private universities and colleges.
Technology will also play a role in scaling this innovation. Online learning, webinars, and the KMTC digital platform will supplement in-person training. This will make it accessible to a broader audience of health care professionals in remote or underserved areas.
Finally, the curriculum will be dynamic and adapt to new legal precedents, changes in health care technology, and evolving patient care standards. An ongoing process of evaluation and revision, based on feedback from students, oversight institutions and legal experts, will help keep the program current and effective.
PHR is excited that the partnership with KMTC has already produced enthusiasm and positive feedback from students and faculty alike. But the real results of this scaling are yet to come. In the words of Mr. Mutua, the long-term impact of the revamped curriculum promises to be a game-changer. “The collaboration between the health care providers, law enforcement and legal systems will ultimately improve,” said Mutua. “This shared knowledge will foster trust and efficiency in resolving forensic cases benefiting both the victims of sexual and gender-based violence and Kenya’s justice system as a whole.”
We could not agree more.