Healthcare Responding to Violence and Abuse (HERA) is a This is collaborative research between Dhulikhel Hospital, Kathmandu University Hospital, University at Bristol (UK), London School of Hygiene and Tropical Medicine (LSHTM, UK), University of Peradeniya, Sri Lanka, University of Sao Paolo, Brazil and An Najah University, the Occupied Palestine Territories. It was funded by the NIHR Global Health Research Group Award from 2018 to 2022.

The overall aim of this study in Nepal is to develop and pilot test a complex intervention provided to health care providers at the outreach centers in Dhulikhel Hospital in order to improve health system responses to violence against women. To achieve this broader aim, we followed a multi-level mixed methods approach to assess the health system readiness and women’s turning point (formative phase), to use the findings of this formative phase to develop and adapt the intervention for HCPs, and to evaluate the intervention after implementation. The intervention included a complex training package for HCPs (3 days) for identification, support, and referral of women experiencing domestic violence; and orientation on gender-based violence for members of local mothers’ groups and female community health volunteers (FCHVs). Post-intervention evaluation showed that there was improved readiness of health care providers in identifying and responding to women with domestic violence. Inquiry (n=58) identification (n=38) and referral (n=7) of women with domestic violence increased from 0 each at baseline Women also felt a change in the behavior and approach of healthcare providers: they became more non-judgemental.