Sexual violence (SV) is one of the most serious public health problems and human rights issues in Latin America and the Caribbean (WHO, 2014). In Brazil, almost 15% of women living in rural areas report having suffered SV after they were 15 years old (PAHO, 2014). Those individuals who suffer violence do not always seek help. Denying sexual violence can be a way to avoid reprisals from the abuser, elude police or social workers’ involvement and eliminate stigma generated by disbelief of the abuse from others.

Civil society movements for health reform and women’s rights, various non-governmental organizations (NGOs) and other social actors located in the Brazilian municipality of Campinas, in the state of Sao Paulo, have a long history and vast experience in grassroots participation, coalition building and partnerships. This know-how was developed during the military dictatorship (1964–1985) and has been strengthened since the 1990s.

There was not a specific protocol for institutions to coordinate and offer prevention of and treatment for SV in Campinas until 2001. Through the Iluminar Program (IP), a strategic intersectoral network was established to evaluate the magnitude of this problem, offer prevention and appropriate care and promote a culture of peace.

1. To work collaboratively with different partners to provide victims of violence an effective and comprehensive care in safe and confidential environments
2. To promote a culture of peace alongside intersectoral work on violence prevention
3. To influence state and municipal policies on SV and promotion of a culture of peace

During 2001, given the severity of the problem of SV in Campinas, the municipal Coordination for Women’s Health organized focus group discussions, meetings and seminars with members of social organizations and governmental agencies related to health, education and public security at the state and municipal levels. This was the origin of the IP, based on previous work and effective collaboration among various sectors and organizations (Pedrosa, Grilo Diniz, & Moura, 2016).

The first step was gathering information on the available public services and local NGOs that worked with SV victims. In parallel, the strengths and weakness of existing services were assessed. Next, a program to train health providers, public security agents, teachers, social workers, among others, was designed. In partnership with two Campinas universities and the local women’s movement, the IP provided training and awareness raising courses to over 800 individuals from various sectors during the IP’s first years. Likewise, these individuals trained other colleagues at their respective agencies or institutions.

Peace building is a key IP component (Bunde-Birouste et al., 2004). Women’s legal aid, psychological support and human rights organizations developed sessions to promote a culture of peace from a culturally-sensitive approach. Capacity building is an essential IP strategy.

In the first year of IP implementation, the flow of care was restructured, to connect services and sectors and facilitate humanized care and case referrals. Time between the act of SV and care of the victims was reduced significantly and the number of isolated, duplicated or disconnected actions was diminished (Brigagão, Burgos & Spink, 2016).

The Campinas municipality was the first in Sao Paulo state to develop a rigorous protocol to register and notify cases and effectively treat SV victims. Working collaboratively with different partners was the key to successfully influencing state and municipal policies on SV and promotion of a culture of peace.

Positive synergies between the IP network and programs that seek to influence some of the structural determinants of violence and health have been generated. One example is the Family Health Program, promoted by the National Health Care System (NHCS) and the Bolsa Familia Program, to reduce social exclusion and inequity (Peixoto Ávila, 2013; Soares da Fonseca et al., 2011).

Some of the IP’s guiding principles include: (a) Violence is determined by a wide range of factors; it is a public health problem and a human rights issue. (b) A culture of peace has to be promoted alongside intersectoral work on violence. (c) Protection should be provided to those individuals who seek services, along with priority placed on avoiding re-victimization. (d) Victims of violence need to receive effective and comprehensive health care in a safe and confidential environment.

The intersectoral network is evaluated internally every two months. External evaluations have been carried out by committees comprised of national and international experts. Prestigious Latin American institutions, such as the Latin American Center for the Study of Violence and Health, have also monitored and evaluated the program.

Intersectoral partnerships are essential to influence health and violence determinants such as poverty, inequities and illiteracy (Jones & Barry, 2016; Corbin, Jones, & Barry, 2018).    

Over the years, the strength of IP’s partnerships has waxed and waned, influenced at times by positive cycles of interaction and at times, by negative cycles (Corbin & Mittelmark, 2007: 44–45). The latter occurred, for example, when the appropriate training for each type of professional providing support for victims of SV was defined. Confused expectations and a lack of clarity on shared objectives were two of the factors that, in the initial stage, contributed to this negative cycle.

From the IP’s foundation, the experience of some IP network organizations in sharing power, creating coalitions and alliances, and working in partnership was very important to constructing a supportive culture and a common vision. The role played by the health movement in Campinas was also critically important to modifying the model of care applied in local health services. With the NHCS’ consolidation, services promote comprehensive health for individuals. Practice is based on a holistic and positive vision of health and on the recognition that the key drivers of health and violence are socially determined (Almeida Filho, 2008; Antonovsky, 1996; Benz, Bull, Mittelmark, & Vaandrager, 2014).

This case illustrates that: (1) Intersectoral efforts can be embarked upon by creating unity around a shared objective, which is considered of utmost importance by all actors – in this case, the need to improve and coordinate prevention and treatment of SV. (2) Collaboration is most effective when objectives are clear, when a shared vision of the problem is constructed, and when there is mutual commitment to tackle the same, based on trust and transparency. (3) Effective intersectoral partnership can lead to far-reaching objectives and results, not only in clinical settings but others as well. Through the IP, it has been demonstrated that working together is not purely a technical matter to be resolved by the right administrative arrangements (Delaney, 1994, cited in Cross, Woodall, Green, & Tones, 2015: 199)

• Rede Iluminar Campinas - Cuidando das vítimas de violência sexual

• Coordinación para atender personas en situación de violencia

• Carta da Saúde. Iluminar Campinas

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