Gender-based violence and HERA/IRIS health sector interventions: towards a Bihar model of public health interventions

This article presents a pilot study of the Identification and Referral to Improve Safety (IRIS)/ Healthcare Responding to Violence and Abuse (HERA) model of complex interventions for gender-based violence (GBV) in tertiary healthcare settings in Bihar, India. The study involved field-based intervention training with healthcare providers in two hospitals across four departments. The study emphasises the importance of multi-sectoral responses to GBV and strengthening care pathways in low- and middle-income countries. HERA adapts the UK’s IRIS model-based HERA model, which incorporates community-based organisations due to the lack of a universalised national health system in developing countries. While models like the One-Stop Centres and non-governmental organisation-led approaches are gaining traction in India, they lack rigorous evaluation and evidence of efficacy in reducing GBV. Systemic biases, including encouraging reconciliation with perpetrators and budgetary constraints, often result in poor quality care. Unlike the UK, these models are not integrated with comprehensive social care provisions. This study underscores the need for rigorously tested models led by women survivors tailored to the Indian context to enhance knowledge and development in health and social care for low-income settings.