Build a Standing Health-Sector Response to Intimate Partner Violence in Bangladesh

Diagnosis

Gender-based violence in Bangladesh is not an episodic shock, it is a structural condition of married life. The BBS Violence Against Women survey, cited in the curated note, finds that roughly 73% of married women report intimate partner violence (IPV). When nearly three in four ever-married women experience violence from a partner, this is not a fringe protection issue handled by a few shelters, it is a population-scale public health burden that flows through the same clinics, sub-district hospitals, and maternal care points the health system already runs every day.

That framing matters for ownership. The lead responsible body in the government registry is the Directorate General of Health Services (DGHS), with the Department of Public Health Engineering (DPHE) as a supporting body. The health system is where survivors physically appear, often presenting with injury or maternal complications rather than disclosing violence. A response built inside DGHS, rather than left to ad hoc projects, is the only way to reach a problem at this scale. The current operational reality is that clinical first-line support, safe referral, and documentation are uneven and donor-project dependent, so the system sees the injuries but rarely captures the cause or routes the survivor to safety.

Recommended actions

1. Make survivor-centred clinical response a standing DGHS function.

• Owner: DGHS.
• Mechanism: a DGHS circular establishing first-line support (the WHO LIVES protocol: Listen, Inquire, Validate, Enhance safety, Support) as standard of care at district and upazila health complexes, with a named GBV focal officer per facility.
• Signal it is working: every district hospital and upazila health complex has a designated, trained focal point and a posted referral pathway within the financial year.

1. Stand up a routine IPV case-record and referral register inside the health information system.

• Owner: DGHS (health information / MIS wing).
• Mechanism: add a confidential GBV intake and referral field to the existing facility reporting forms so cases are counted and tracked, not lost in generic injury codes.
• Signal: monthly facility returns begin reporting GBV first-line support and onward referrals as a standing indicator.

1. Guarantee one-stop crisis care at every district hospital.

• Owner: DGHS, with DPHE on facility readiness (private examination space, water, sanitation, secure waiting areas).
• Mechanism: a DGHS service standard requiring each district hospital to provide co-located clinical, forensic-medical, and psychosocial first response with a clear handoff to police and legal aid.
• Signal: each district hospital can document a survivor end to end without sending her to multiple buildings.

1. Fund it as a recurrent budget line, not a project.

• Owner: DGHS, through the Ministry of Health and Family Welfare budget submission.
• Mechanism: a dedicated recurrent line for GBV clinical response (staff time, training, supplies, private rooms) so the service survives the end of any single donor programme.
• Signal: the line appears in the operating budget and is protected across two consecutive fiscal years.

1. Train and supervise the frontline continuously.

• Owner: DGHS in-service training cadre.
• Mechanism: embed first-line support and safe documentation into routine in-service training and supervisory checklists, not one-off workshops.
• Signal: supervision visits begin scoring GBV readiness as a standard item.

Sequencing (first 12 months)

Issue the DGHS circular first (action 1): it is the legal anchor that names focal officers and makes the protocol standard of care, and nothing else is enforceable without it. In parallel, add the GBV field to existing reporting forms (action 2), because once the circular names the function, you immediately need to count it. With focal officers named and a register live, district one-stop care (action 3) and continuous training (action 5) have a structure to attach to. Securing the recurrent budget line (action 4) should be locked into the next budget cycle so the year-one circular does not lapse into another unfunded mandate.

Risks and constraints

The binding constraints are fiscal and institutional. A recurrent budget line competes with established health priorities, and GBV response is easily cut when revenue is tight. Health staff are already overstretched, so any new task without protected time and supervision will be quietly dropped. There is also a disclosure-and-safety risk: counting cases without confidentiality and a real referral destination can expose survivors rather than protect them, so the register and the referral pathway must come together, never the register alone.

Bottom line

When roughly 73% of married women report intimate partner violence, the health system is already the front line whether or not it is organised for it, so DGHS should convert that contact into protocol-driven, funded, survivor-centred care. The single highest-leverage first move is the DGHS circular that names a focal officer in every facility and makes first-line support standard of care, because it turns a population-scale problem from a project into a permanent function.