Where the streets have no names: factors associated with the provision of counselling and social work services for child rape survivors in KwaZulu-Natal, South Africa

Objective: The aim of this study was to audit the provision of state-assisted counselling and social work services to child rape survivors presenting for medico-legal assessment at a state hospital in KwaZulu-Natal, South Africa. Method: A prospective design was used to collect data from the social and medical case files of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa). For each case, information was obtained regarding survivor and offender demographics, the nature and duration of abuse, and the extent and nature of counselling and social work services provided. Results: Only 49% of survivors benefited from state-supported counselling and social work services, with the provision of such services being frequently delayed (by periods of up to six months), and with service provision being restricted to a single intake interview in all but one case. Social work service provision was significantly less likely in cases where the survivor resided in an informal dwelling (OR = 0.507) and where the child presented for medico-legal assessment outside of normal working hours (OR = 0.625). From observations made during the study, it would appear that patterns of professional collaboration in relation to service provision for child rape survivors falls somewhat short of the ideal of effective multi-sectoral engagement. Conclusions: Levels of service provision observed in the study are unacceptably low, with there being a clear need for the development and implementation of carefully considered multi-sectoral protocols which are designed to effectively meet the needs of all child rape survivors.