Table 2 Summarises the key results, according to the study framework

Actor power

The strength of the individuals and organizations concerned with the issue

1. Policy community cohesion: Ministry Of Women (MOW) and women’s NGOs allied to pass the Prevention of Domestic Violence Act (PDVA) Bill. However, strong parliamentarian opposition (supporting traditional family values) diluted the Bill. New Government seems more responsive with adoption of VAW Plan in 2016

2. Leadership: the presence of women’s NGOs helped push the PDVA Bill onto the policy agenda. However, cultural and religious views upheld by majority of politicians prevailed and diluted the Act. The presence of a policy champion, internationally recognised for her role as Special Rapporteurs on VAW, helped set VAW high on national agenda.

3. Guiding institutions: MOW was effective in developing national machinery on VAW, though limited recognition and several additional issues to work on. International agencies to influence acceptance of VAW as public health as they funded reports and programmes.

4. Civil society mobilization: grassroots organizations mobilized to press national political authorities to address VAW, though marginal power as not viewed as political actors by the Government.

Ideas

Initially framed as a human right, following international movement.

Then, viewed also as a public health issue, though high-level policy-makers viewed it as a threat to family unit

5. Internal frame: All State and on State actors agreed that IPV was a policy issue of concern. However, the politicians and NGO communities did not agree on the definition of IPV, its causes, and solutions to the problem.

6. External frame: President, MPs and Magistrate Court publicly pushed the ideology of family unit, suggesting that IPV is part of married life. Such ideology negatively influenced professionals’ views towards IPV.

Issue characteristics

IPV is pervasive, though no national prevalence data is available (also detailing types of VAW and health consequences). Limited health systems responses.

7. Credible indicators: no clear measures that show the severity of VAW. Data not reliable, primarily coming from cases reported to police.

8. Severity: studies show range from 20 to 72%. However, VAW has to compete with other high mortality non-communicable diseases.

9. Effective interventions: Available models of health response for IPV (primarily at hospital level), though anecdotal evidence show their inadequacy.

Political context

Limited political leadership, support and financial resources to IPV. Strong support and influence from international institutions allowed for a health response to VAW.

10. Policy windows: The proclamation of the PDVA Bill was an important political moment, presenting opportunities for women’s advocates to influence decision makers on VAW, and for other Ministries, such as MOH, to legitimise their role in the national response to VAW. Political elections with the regime change also offered a renewed opportunity to push for a concerted national response to VAW.

11. Global governance structure: limited influence from ratifying international VAW governance structures (e.g. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)), though financial (and technical) influence from international agencies to deliver health systems response.