Supporting a New Partnership One Stop Crisis Center

The following story is based on the experience of Geeta Misra, a grantmaker, and her grantee partners, who working together developed a One Stop
Crisis Center for abused women in Maharastra, India. In this story Geeta reflects on her role in the development of this new center. Grantmakers working in other fields will appreciate insights on issues such as:

  • Responding to an unexpected opportunity
  • Encouraging NGOs to partner with government
  • Creating a learning environment through a study tour

Geeta Misra
Program Officer (1995-2001), The Ford Foundation

I think domestic violence is a “tradition” everywhere in the world, and even research in western countries shows the rates of domestic violence have not come down. In India, the reason why women don’t break the silence is because there is nothing they can get from it.

Dr. Seema Malik
Medical Superintendent, Bhabha Hospital Director of Dilaasa, the One Stop Crisis Center

We were really trained not to write anything. We are the doctors. Our job is to treat the patients and let them go back. We are not going to talk to them for anything else; it’s the police’s job, it’s not our job.

Sridevi Goyal
Director, Prevention of Atrocities on Women Branch, India Police Service

Police alone cannot do anything. We require the help of NGOs. After all, offenses against women are a sort of social offense. And for that, we just cannot go and knock at a house and bring the husband to the police station and lock up the mother-in-law. That would break down the whole family support system.

Dr. Alka Karende
Executive Health Officer, Brihanmumbai Municipal Corporation

What I feel is that a hospital is the right place because when a woman gets beaten up, it is not the police she will first run to. What she most needs at that time is for her injuries to be attended to, whether they are physical or mental. You cannot solve these problems overnight, but a process has to at least begin.

Geeta Misra

A lot of my work in the Ford Foundation is looking at the field of reproductive and sexual health. I began to see that a lot of issues of reproductive and sexual health are intertwined with gender violence.

Traditionally, violence hasn’t been seen as a health issue, and definitely not as a reproductive health issue. We decided to have a regional meeting with the five program officers from the surrounding countries: Vietnam and Thailand, Indonesia, Philippines, China and India. In each of our countries, we decided to bring two grantees from the reproductive health field and two grantees from the human rights field so that we could actually have a discussion that would interlink both these fields.

We also decided to invite some external resource people. In fact, it was my colleague who had been to a meeting about the police in Bangladesh who had heard Dr. Hassan from Malaysia. Some of the other program officers had also heard of him and his work and were very excited.

We had this meeting in 1998 where Doctor Hassan presented his work with the crisis center in Malaysia. He was seeing a lot of women who were coming into the hospital battered and abused and their needs were not being addressed. So he developed this concept of a One Stop Crisis Center where women could come into one space in a hospital and their legal needs, their counseling needs, and their health needs could all be addressed. That center could be connected with the shelters in that city. After a couple of years it became mandatory by law for all hospitals in Malaysia to have a crisis center.

It was that piece that sounded really exciting.

Responding to an Unusual Opportunity

Geeta Misra

At the meeting itself, Dr. Amar Jesani – the participant from one of my grantee organizations, CEHAT – and I had a very casual conversation about how great it would be if we had One Stop Crisis Centers in India. A few months later he had actually done a lot of research on what the Philippines had done on this issue. He came back and he said that he was willing to explore the idea of doing something like that with the Bombay Municipal Corporation (BMC).

They had already been working with another NGO to make their health care services more women centered, but we really felt that to address issues of scale it was not okay for just CEHAT to go and begin a One Stop Crisis Center in a hospital.

You couldn’t set up a One Stop Crisis Center in an NGO. They would only serve a few people. I think the analogy I draw is this whole idea that when we fund NGOs alone we create these wonderful islands of excellence. But they are still islands and you have to walk through water to get from one to the other. We needed to bring them together to create a bigger mass and to create more impact.

We knew that we would have to work with the public health system to achieve greater impact.

Dr. Amar Jesani
Coordinator, CEHAT

Government/NGO relationships have always been very contradictory in India. We as an NGO can never replace the need for government intervention in health care for needy people. The Malaysian and Philippine experiences told us that it is possible to motivate them, to link up with them, and the strategy was to find the right kind of people within those structures who were interested in this kind of work. We have not looked for them, so why don’t we go and look for them?

Encouraging NGOs to Partner with Government

Geeta Misra

We both made a commitment to talk anytime we got a chance about what we had heard about the Philippines experience, the Malaysian experience. Amar did a lot of the legwork in getting the curiosity of the BMC officials.

Dr. Seema Malik

I had a very wrong impression in the beginning – I thought NGOs only talk, they don’t do anything. There’s no action. Anyway, I said that if they could do anything, show me. Bring in your project.

Dr. Alka Karende

They told us what had been done in places like Malaysia and Manila, and they asked if our officers would like to see that and if we could do something like that in the city of Bombay. I immediately agreed.

Geeta Misra

If it has happened in some other country, why hasn’t it happened here? We were hoping to capitalize on that.

The idea of the study tour came about early on. You really learn so much more from actually seeing what’s happened. At first, we thought of going only to Malaysia and only to Doctor Hassan’s office, but Amar came to me and said that if we were going all the way to Malaysia why couldn’t we also go to the Philippines? It made sense because then we would also see a comparative model of crisis centers.

We wanted to take Doctor Alka Karande, and we quickly decided that we should definitely take the head of the hospital where we wanted the One Stop Crisis Center to begin.

It was a huge process. It took nine months just for the BMC officials to get permission to travel to the Philippines and Malaysia. The government does not easily allow government officials to travel outside the country. Until the night before we left, we did not have permission for Alka to travel. We kept delaying the trip day by day and we had a deadline of Monday evening. It was Monday at six o’clock in the evening when she got permission and we all flew out at ten o’clock that night.

Creating a Learning Environment Through a Study Tour

Geeta Misra

We were all together for nine days and we used that time really well to build a perspective.

Dr. Alka Karende

What I liked most was that a woman who had undergone violence was given all the possible facilities under one roof, and it was a hospital. Many of the centers were run in coordination with the NGOs, and NGOs have tremendous potential. I thought it would be a good venture.

Geeta Misra

In the beginning there was a lot of formality between the NGO and the government. I was able to do things that the NGO could not have done like equalize some of the dynamic among the NGO, the government, and the funder. I think the government officials were quite surprised when I addressed them by first name; or when we said we should all go out together.

Dr. Seema Malik

We all went everywhere together and we all learned together. On the last day, all of us sat together, and one by one we discussed what we found, and what we were going to do about it. And we actually criticized each other. Amar and Geeta, both of them were there, so that really helped us because that day our roles became clear. We knew who had to do what. We felt it was our project.

Developing a One Stop Crisis Center

Dr. Amar Jesani

After coming back it was very easy. A framework for it was prepared. We went to see the higher–ups in the Municipal Corporation on the same day. We had to explain the strategy, saying that we would start on an experimental basis at one hospital for two years. At the end of two years we would do the evaluations, see how it was working and how it could be integrated into the BMC’s health work in the future. On the basis of that we would work our strategy of replicating at the other hospitals. Then the team doing the experiment could train the other hospitals and it would be everywhere.

Geeta Misra

What we were going to do was give a grant for a One Stop Crisis Center to be established. We were going to provide funds for the hospital staff to be trained and to be able to begin to provide services. Then over three years’ time, it would be up to the BMC to carry the work forward. That was great because it would give them a chance to think about it more deeply, more seriously.

Dr. Amar Jesani

The Deputy Municipal Comissioner was convinced and he said to go ahead. The final proposal was prepared and a memorandum of understanding was signed by the three parties.

Manisha Gupte

We’ve called it One Stop Crisis Center Dilaasa, which in Hindustani means reassurance and support. It’s understood equally by both Hindus and Muslims. Dilassa is the One Stop Crisis Center that is equally owned emotionally by the Bhabha Hospital, the BMC and CEHAT.

Dr. Seema Malik

I had many challenges in my mind. First of all, are the doctors, the nurses, the labor staff, and of course, the union representatives all going to accept it? We really had to boost them up. This was a big speech I had to give: “See those people standing on the road? They have no backing, but here you have complete backing in the hospital to help them. This center is the first of its kind and everyone will remember the Bhabha Hospital employees.”

Renu Khanna
Resource Person and Trainer, Bhabha Hospital

There were about 882 people within the hospital. So as a strategy it seemed a good idea to have a pool of key trainers within the Bhabha Hospital, who could in turn orient all the staff and do capacity building with them.

Dr. Seema Malik

And once this is over, we’ll go to the police. We want to have training for them, too.

Geeta Misra

What CEHAT is doing now is saying that there is this One Stop Crisis Center that can address women’s needs – whether it’s the police, the law, shelter, or health services – in one place. For the first time in India, there is an actual entity that can address these issues.

Renu Khanna

It’s been an eye-opener. It’s one thing to be working in a small NGO at the micro-level and it’s another thing to be working in a large public system, dealing with millions of people like the Bombay Municipal Corporation is doing. Suddenly you find yourself on the same side with added responsibility because you can’t stand outside and critique the system. You have to engage the system in making it responsive. We want to see it taking roots in the national health policy. But the immediate challenge is to really make it happen here.

Dr. Alka Karende

Once people see the success of the project, I think many more will be ready to be a part of it.

Geeta Misra

What I’m hoping is that with the beginning of this in one center it will expand, that there’ll be a demand at the community level to provide this service. And there’ll be demand by the NGOs to keep doing it well, so that services for battered women become an integral part of the health system in the country.