MGHD 2022

Overview One of the most significant public health issues affecting a substantial number of individuals worldwide is gender-based violence (GBV). To better assist GBV survivors, Rwanda began the Isange One-Stop Center (IOSC) program to provide comprehensive services to survivors inclusive of mental health support. Studies exploring experiences and challenges of service providers in mental health service provision and the intersectionality of services are scarce. Objective The study's goal was to understand the challenges of service providers in the practice of mental service provision at urban and rural one-stop centers. The study aimed to identify gaps and areas of improvement for enhancing the delivery of psychosocial services at IOSC. In addition, the study tries to give insights through the lens of the intersectionality framework. Methods The study is a qualitative phenomenological study, where 18 in-depth interviews were carried out using a semi-structured interview guide in June 2022. Participants included a multi-sectoral set of service providers involved in providing psychosocial support to GBV survivors at IOSCs in urban and rural settings. The data was analyzed through Dedoose software. Results Five major themes emerged. These include the psychological impact of working at the IOSCs on service providers, barriers to accessing mental health services, service providers' perspectives on the role of intersectionality in mental health service provision, and a comparison of the services offered to GBV survivors in the two studies settings. In addition, there is a theme on service providers' suggestions for improving IOSC services. Each theme is broken down into sub-themes that explain the findings in greater depth. The study revealed that working at the IOSCs had a significant psychosocial impact on the service providers with little support available at the centers. It also showed that the shortage of financial resources at IOSCs and obstacles faced by survivors such as culture, stigma, lack of transport, and information influenced access to services. When comparing results based on the setting, the lack of mental health experts and full-time staff in rural IOSC impacted the level of mental health services provided. Furthermore, it was evident that providers need more regular training in various aspects of service delivery, including mental health provision. The understanding of different social groups by providers seemed to be lacking. Service providers also recommended capacity building to enhance their knowledge of intersectionality to tailor services based on the needs of survivors. On the other hand, this study demonstrates the strength of the Isange one-stop centers in its efforts to utilize available resources to deliver comprehensive services to GBV survivors. Conclusion According to the study's findings, the level of psychosocial support provided to GBV survivors varied across rural and urban centers. Therefore, more attention needs to be given to reviewing the operations of IOSC facilities in different settings and addressing the gaps identified. Additionally, identifying the effects that providing this service has on the service providers' mental health and responding to this impact must be made a priority.