Implementation of Prevention Strategies
Promoting violence prevention involves encouraging and supporting the development, implementation, and evaluation of programs explicitly designed to stop the perpetration of violence at local, regional, and national levels.
The 2003 World Health Assembly Resolution (WHA56.24) on implementing the recommendations of the World Report on Violence and Health (Krug and others 2002b; see also Butchart and others 2004) advocates a five-point strategy.
Increasing Capacity for Collecting and Managing Data
Increased capacity for collecting health, criminal justice, and social service sector data on violence and its consequences is fundamental to building a sustained, high-level policy and intervention programming response in LMICs. Population-level data are needed to design and evaluate community-level intervention trials. Health sector data can cover a larger and often different subset of violence-related injuries than police statistics and, with criminal justice and social service data, can strengthen abilities to define the problem, identify causes and risk factors, design appropriate interventions, and monitor the interventions' effectiveness.
Information systems play a large role in recent efforts to address infectious diseases such as tuberculosis and HIV, allowing better identification of high-risk populations and appropriate interventions. A similar role is imminent for violence prevention. As previously stated, information systems must integrate data from the criminal justice, labor, education, social services, and health sectors and must be linked with systems housed at multilateral agencies or regional joint initiatives. Sharing information regionally allows countries to identify opportunities for collaboration and to share best practices.
Support for Research
Supporting research on the causes, consequences, and prevention of violence has proven effective in mobilizing prevention responses in developing countries. In South Africa, the 1997 Essential National Health Research Conference identified research for improved violence prevention and control as a top priority, and in 2001, the Medical Research Council established a program to give violence prevention research the same priority as research into HIV/AIDS, tuberculosis, and malaria (Jeenah and others 1997; Medical Research Council of South Africa 2004). South Africa also has applied research data in various prevention contexts, including establishment of a national violence and injury mortality surveillance system, passage of firearms legislation, assessment of national and municipal-level burden-of-disease estimates, and design of prevention programs (Butchart and others 2001; Groenewald and others 2003).
The currently limited evidence base and understanding of the causes of all types of violence must be expanded through planned, documented, evaluated, and shared research. Some developing countries have opportunities to develop and document prevention programs in special settings, such as for refugees, orphans, nomadic, displaced, and homeless populations.
Promoting Primary Prevention
An important first step in promoting primary prevention is systematic documentation of existing prevention programs. Records can include information on the types of violence and risk factors addressed, target populations served, interventions used, and any monitoring and measurement of the effects. Such information can help make the programs more visible to policy makers and development partners and can be used to promote increased investment in programs that apply proven and promising interventions.
WHO has outlined a methodology for systematic documentation (Sethi, Marais, and others 2004, 22-33) and has initiated a project to evaluate the feasibility and utility of such documentation in selected cities and provinces in Brazil, India, Jamaica, Jordan, the former Yugoslav Republic of Macedonia, Mozambique, the Russian Federation, and South Africa.
Strengthening Support Services for Victims
A situational analysis of the accessibility and organization of emergency, acute, long-term, and rehabilitative services can identify needs and help strengthen care and support services for victims of violence. The establishment and adequate funding of first responder systems, such as police and ambulance teams, may lower the costs of violence and contribute to prevention. Maps showing hospitals and clinics with specialized systems for treating victims of violence can help these first responders. Ready access to legal resources empowers victims. Mock and others (2004) offer guidelines for strengthening victim care and support services.
Claramunt and Cortes's (2003) assessment in Belize, Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua established baseline information that could be used to advocate for strengthened medical and legal services for victims of sexual violence. Their findings included a lack of adequate medical and legal information systems, the insufficient training of medical staff, and a lack of clear protocols for moving patients through the system. Services in associated sectors—medical, forensic, social, and legal—should be examined, because integrated efforts can improve access to and value of services that previously existed in isolation. Training of medical and legal service providers in activities aimed at preventing violence may also affect the success of long-term prevention; however, this training strategy has not been extensively evaluated.
Developing Action Plans
A national plan of action for preventing interpersonal violence and improving victim support and care is the blueprint that provides a set of common goals, a shared time frame, a strategy for coordinating activities, and a framework for evaluating the different sectors involved. Such a plan is therefore central to organizing national and community-level interventions that involve more than one objective and that depend on input from many different sectors. Strong political support from the highest levels of government is important in aligning the various players and ensuring that the plan is implemented and that associated programs are maintained. Nongovernmental organizations may provide support and continuity in countries where programs may be interrupted because of unstable, changing governments.
Collaboration among national governments and health-related nongovernmental and multilateral organizations can establish the importance of formally addressing violence through public health approaches. Though legal and criminal justice approaches provide a deterrent, experience in high-income countries suggests that a proactive public health approach can reduce the negative health, social, and economic consequences of interpersonal violence.
