Chikwanekwane — Blantyre's Hospital-Based One-Stop Centre for Child Survivors of Sexual Abuse, Malawi (Evaluated, With Mixed Results)

Chikwanekwane ("everything under one roof" in Chichewa) is Malawi's first one-stop centre for survivors of sexual violence, built in 2012 at Queen Elizabeth Central Hospital in Blantyre with UK aid (DFID) funding through UNICEF, on the basis of a multidisciplinary team working there since 2010. Paediatricians, nurses, social workers, police Victim Support Unit officers and volunteer counsellors provide a medico-legal examination, HIV testing and post-exposure prophylaxis, STI care, emergency contraception, counselling and home visits.
A mixed-methods study (Mulambia et al., BMC Pediatrics 2018) followed 228 children aged 0-14 (99% girls) seen between August 2012 and June 2013; 107 guardians completed a three-month questionnaire. All children received a medical examination and HIV test, about 83% had the 3-month follow-up HIV test, 84% saw a counsellor and 95% had a police report. However only 29% received a social-welfare home visit (mainly for lack of transport), 27.1% of cases ended in a criminal conviction, and just 18% received all services required by national guidelines.
73.8% of guardians were satisfied and 26.2% were not; the main complaint was the police response, including perceived corruption or negligence. The authors conclude the model is appropriate for Malawi but note limits: 26% of eligible families did not take part, the child was not interviewed, the sample was urban only, and satisfaction analysis may have lacked power. Press reporting (Bhekisisa, 2019) says the centre saw fewer than 50 patients a month between 2014 and 2018, which a UNICEF child-protection chief called a drop in the ocean of need. Lessons: co-location delivered clinical care reliably, but justice outcomes, transport for follow-up and rural reach remain gaps.

Read the full analysis: https://bmcpediatrics.biomedcentral.com/articles/10.1186/s12887-018-1121-z